Massive surgical emphysema following transanal endoscopic microsurgery

Abstract

We describe an impressive and rare case of surgical emphysema after minimally invasive rectal surgery. This case reports on a patient who developed massive retroperitoneal, intraperitoneal and subcutaneous emphysema directly following a transanal endoscopic microsurgery (TEM) procedure for a rectal intramucosal carcinoma. Free intra-abdominal air after gastro-intestinal surgery can be a sign of a bowel perforation or anastomotic leakage. This is a serious complication often requiring immediate surgery. In our patient an abdominal computed tomography-scan with rectal contrast showed no signs of a rectal perforation. Therefore this emphysema was caused by the insufflation of CO₂ gas in the rectum during the TEM-procedure. Conservative treatment resulted in an uneventful recovery. With the increasing usage of TEM for rectal lesions we expect this complication to occur more often. After ruling out a full thickness rectal wall perforation in patients with surgical emphysema following TEM, conservative treatment is the treatment of choice.

Keywords: Transanal endoscopic microsurgery; Microsurgery; Gastrointestinal endoscopy; Colorectal neoplasms; Retropneumoperitoneum; Intraperitoneal emphysema; Subcutaneous emphysema

Core tip: Surgical emphysema after transanal endoscopic microsurgery (TEM) can be a sign of a rectal perforation. This report describes a patient with impressive retroperitoneal, intraperitoneal and subcutaneous emphysema directly following TEM without a full thickness rectal wall perforation. This is a rare complication after TEM in which conservative treatment resulted in an uneventful recovery.