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Inicio Cirugía Española (English Edition) Pneumomediastinum and Cervical Emphysema as a Debut of Colorectal Anastomotic Le...
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Vol. 93. Núm. 8.
Páginas e81 (octubre 2015)
Vol. 93. Núm. 8.
Páginas e81 (octubre 2015)
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Pneumomediastinum and Cervical Emphysema as a Debut of Colorectal Anastomotic Leakage
Neumomediastino y enfisema cervical como comienzo de dehiscencia de anastomosis colorrectal
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Roberto de la Plaza Llamas
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rdplazal@sescam.jccm.es

Corresponding author.
, José Manuel Ramia Ángel, Cristina García Amador, Aylhin Joana López Marcano
Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, Spain
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The patient is an 83-year-old woman with Alzheimer's who had been discharged 4 days earlier after a sigmoidectomy performed 11 days before due to sigmoid adenocarcinoma (pT3N0). She came to the hospital because of general malaise, cough and dyspnoea. Physical examination detected bilateral laterocervical subcutaneous emphysema. Work-up showed lactic acid 2.5mmoL/L, neutrophils 12,860/μL and C-reactive protein 466.5mg/L. A chest radiograph (Fig. 1) showed (from top to bottom) subcutaneous emphysema in the cervical region, pneumomediastinum and retropneumoperitoneum. Thoracoabdominal computed tomography (CT) with intravenous and endorectal contrast revealed, on the axial view (Fig. 2): retroperitoneal contrast (arrow), anastomotic dehiscence and adjacent extravasation of contrast (circle). The coronal slice demonstrated (Fig. 3): retropneumoperitoneum and extravasation of retroperitoneal contrast. The patient was treated surgically, at which time we found dehiscence of the colorectal anastomosis. Cultures were positive for Enterococcus, Bacteroides, Clostridium and Morganella morganii. Hartmann's procedure was performed and a drain inserted. The patient was discharged 60 days later.

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Please cite this article as: de la Plaza Llamas R, Ramia Ángel JM, García Amador C, López Marcano AJ. Neumomediastino y enfisema cervical como comienzo de dehiscencia de anastomosis colorrectal. Cir Esp. 2015;93:e81.

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