Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2024; 12(4): 859-864
Published online Feb 6, 2024. doi: 10.12998/wjcc.v12.i4.859
Perforated gastric ulcer causing mediastinal emphysema: A case report
Zhi-Cheng Dai, Xun-Wu Gui, Feng-He Yang, Hao-Yuan Zhang, Wen-Feng Zhang
Zhi-Cheng Dai, Xun-Wu Gui, Feng-He Yang, Wen-Feng Zhang, Department of General Surgery, Mengcheng County First People's Hospital, Mengcheng 233500, Anhui Province, China
Hao-Yuan Zhang, Department of Medical Imaging, Mengcheng County First People's Hospital, Mengcheng 233500, Anhui Province, China
Author contributions: Dai ZC, Yang FH, and Gui XW compiled the literature and data; Dai ZC and Zhang HY drafted the paper and prepared the figures; Dai ZC and Zhang WF reviewed and revised the final version of the paper.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Feng Zhang, MD, Chief Physician, Department of General Surgery, Mengcheng County First People's Hospital, No. 282 Shangcheng East Road, Mengcheng 233500, Anhui Province, China. zwf197801@163.com
Received: December 3, 2023
Peer-review started: December 3, 2023
First decision: December 12, 2023
Revised: December 14, 2023
Accepted: January 8, 2024
Article in press: January 8, 2024
Published online: February 6, 2024
Processing time: 52 Days and 21.6 Hours
Core Tip

Core Tip: Abdominal free gas from a perforated gastric ulcer may pass through the lax esophageal hiatus into the mediastinum and then travel up to the neck and chest wall. This condition should be differentiated from esophageal perforation, and upper gastrointestinal angiography can clarify the diagnosis. In such patients, the pneumoperitoneum for laparoscopic surgery increases the pressure in the abdominal cavity, not only causing elevation of the diaphragm but also allowing more gas to enter the mediastinum through the esophageal hiatus. Open surgery may be preferred. Thoracic epidural anesthesia combined with intravenous anesthesia can prevent the effect of mechanical ventilation on the mediastinum.