Buscar en
Gastroenterología y Hepatología (English Edition)
Toda la web
Inicio Gastroenterología y Hepatología (English Edition) Subcutaneous emphysema secondary to intestinal perforation in a patient with Cro...
Journal Information
Vol. 42. Issue 10.
Pages 636-637 (December 2019)
Vol. 42. Issue 10.
Pages 636-637 (December 2019)
Image of the month
Full text access
Subcutaneous emphysema secondary to intestinal perforation in a patient with Crohn’s disease
Enfisema subcutáneo secundario a perforación intestinal en paciente con enfermedad de Crohn
Visits
...
Diego Casas Dezaa,
Corresponding author
diegocasas8@gmail.com

Corresponding author.
, Marta Gascón Ruizb, Rosa García Fenollc, Santiago García Lópeza
a Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, Spain
b Servicio de Oncología Médica, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
c Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (1)
Full Text

We present the case of a 71-year-old man with long-standing Crohn’s disease (A2B2L3), with stenosis of the distal ileum leading to dilation of the small intestine. He was on treatment with golimumab, azathioprine and prednisone. He was admitted due to signs and symptoms of a partial occlusion with a slowly favourable course. Suddenly, the patient presented a poor general condition and abdominal pain. An examination revealed crepitation of the subcutaneous tissue. An emergency scan revealed the findings below (Fig. 1).

Fig. 1.

Images A, B and C show the patient’s subcutaneous emphysema extending from the underarm (A) to the right testicle (C). Image D shows the eviscerated loop causing the perforation from which the patient’s emphysema originated.

(0.37MB).

The images show subcutaneous emphysema extending from the right axillary region to the ipsilateral testicle, resulting from a spontaneous perforation originating from an eviscerated loop. This perforation was visualised in the operating theatre and corrected with a single suture.

Intestinal perforation is a rare complication (1.5 %),1 even during colonoscopies,2 but it is a serious complication of Crohn’s disease. The most sensitive test for its diagnosis is computed tomography.3,4 As in our patient, it usually occurs in isolation and in patients with a stenosing–fistulising pattern. This complication is treated by means of surgery, usually emergency surgery. At the same time, medical treatment must be optimised by means of broad-spectrum antibiotic coverage and nutritional support.5

References
[1]
J.W. Kim, H.-S. Lee, B.D. Ye, S.-K. Yang, S.W. Hwang, S.H. Park, et al.
Incidence of and risk factors for free bowel perforation in patients with Crohn’s disease.
Dig Dis Sci, 62 (2017), pp. 1607-1614
[2]
R. Makkar, S. Bo.
Colonoscopic perforation in inflammatory bowel disease.
Gastroenterol Hepatol (N Y), 9 (2013), pp. 573-583
[3]
R.T. Griffey, K.J. Fowler, A. Theilen, A. Gutierrez.
Considerations in imaging among emergency department patients with inflammatory bowel disease.
Ann Emerg Med, 69 (2017), pp. 587-599
[4]
B. Bagga, A. Kumar, A. Chahal, S. Gamanagatti, S. Kumar.
Traumatic airway injuries: role of imaging.
Curr Probl Diagn Radiol, (2018),
[5]
S.A. Patil, R.K. Cross.
Medical versus surgical management of penetrating Crohn’s disease: the current situation and future perspectives.
Expert Rev Gastroenterol Hepatol, 11 (2017), pp. 843-848

Please cite this article as: Casas Deza D, Gascón Ruiz M, García Fenoll R, García López S. Enfisema subcutáneo secundario a perforación intestinal en paciente con enfermedad de Crohn. Gastroenterol Hepatol. 2019;42:636–637.

Copyright © 2019. Elsevier España, S.L.U.. All rights reserved
Article options
Tools
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos