Subcutaneous emphysema due to rectal perforation: A case report

Table 1 Clinical characteristics of patients with subcutaneous emphysema due to intestinal perforation

Ref.	Age/sex	Location	Causes	Signs of peritonitis	Treatment/surgery
Setoguchi et al[17]	66, M	Sigmoid	Colonic diverticular	No	Sigmoid colostomy
Turco and Trivedi[18]	71, F	Rectum	HAL-RAR	No	Sigmoid colostomy
Kurti et al[19]	55, F	Rectum	Rectal diverticulosis	Inapparent	Segmental intestinal resection and anastomosis
Gupta et al[20]	83, F	Rectum	Fecal-associated perforation	No	Sigmoid colostomy
Janczak et al[2]	76, F	Sigmoid	Colonic diverticular	No	Colostomy
Lee et al[21]	62, F	Rectum	Rectal prolapse	No	Diverting sigmoid loop colostomy
Morita et al[22]	73, M	Rectum	Rectal cancer	NR	Colostomy
Fox et al[23]	46, M	Rectum-sigmoid	Rectal cancer	No	Right transverse colostomy
	72, M	Rectum-sigmoid	Colonic diverticular	No	Right transverse colostomy

F: Female; M: Male; HAL-RAR: Hemorrhoidal artery ligation and recto anal repair; NR: No report.

Table 2 Imaging findings in patients with subcutaneous emphysema due to intestinal perforation

Ref.	Age/sex	Imaging findings
Setoguchi et al[17]	66, M	CT imaging demonstrated subcutaneous (neck), mediastinal, and retroperitoneal emphysema, with no evidence of free air
Turco and Trivedi[18]	71, F	CT of the abdomen and pelvis demonstrated extensive extraluminal gas distribution throughout the neck, torso, and upper limbs. The gas was detected in various regions, including the retroperitoneal and intraperitoneal spaces, the mediastinum, the anterior and posterior chest walls, the superficial and deep cervical layers, the right lower abdominal wall, and the bilateral inguinal canals
Kurti et al[19]	55, F	CT imaging showed the presence of air bubbles in both perirenal areas. These air bubbles propagated to the mediastinum and spread laterally into the subcutaneous tissues. Notably, they were mainly present in the left subaxillary and supraclavicular spaces and ultimately reached the structures of the neck
Gupta et al[20]	83, F	CT of the abdomen and pelvis disclosed a fecaloma accompanied by pneumatosis. The abnormal gas was identified in the mediastinum, abdomen, and the subcutaneous tissues covering the chest and abdomen
Janczak et al[2]	76, F	CT examination revealed massive left-sided intra-abdominal and subcutaneous emphysema, as well as right-sided intramuscular emphysema of the chest. The gas predominantly accumulated in the right iliac fossa, and a large gas sac, measuring 6 cm × 8 cm, was situated to the right of the midline
Lee et al[21]	62, F	CT findings indicated a thickened rectosigmoid colon surrounded by a substantial amount of free air. Extensive surgical emphysema was observed, extending to the chest wall and groin regions. Additionally, large quantities of free air were present within the retroperitoneal space and around the aorta
Morita et al[22]	73, M	CT imaging demonstrated emphysema around the buttock, lower abdominal wall, and both lower extremities
Fox et al[23]	46, M	Roentgenograms of the abdomen and left lower extremity showed the presence of air within the soft tissues along the fascial planes
	72, M	Abdominal roentgenograms revealed soft-tissue gas in the left hip area

F: Female; M: Male; CT: Computed tomography.