Case Report
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World J Gastrointest Surg. Aug 27, 2014; 6(8): 160-163
Published online Aug 27, 2014. doi: 10.4240/wjgs.v6.i8.160
Massive surgical emphysema following transanal endoscopic microsurgery
Geert AAM Simkens, Simon W Nienhuijs, Misha DP Luyer, Ignace HJT de Hingh
Geert AAM Simkens, Simon W Nienhuijs, Misha DP Luyer, Ignace HJT de Hingh, Department of Surgical Oncology, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, The Netherlands
Author contributions: Simkens GAAM, Nienhuijs SW, Luyer MDP and de Hingh IHJT contributed equally to this work.
Correspondence to: Ignace HJT de Hingh, MD, PhD, Department of Surgical Oncology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands. ignace.d.hingh@cze.nl
Telephone: +31-40-2399111 Fax: +31-40-2455035
Received: January 25, 2014
Revised: May 18, 2014
Accepted: July 12, 2014
Published online: August 27, 2014
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.