A 5-year-old boy was on medication after diagnosed with infantile spasm, and had regular diet with bedridden state. The patient had intermittent fever and cough lasting 1 week before admission. Symptom was worsened from the night before the first day of admission, and chest swelled up on the day of admission. Chest computed tomography (CT) was performed and showed extensive subcutaneous emphysema in neck, thorax, and abdomen. Pneumomediastinum, pneumoretroperitoneum, and right lung atelectasis was accompanied. An emergency bronchoscopy was performed because of the suspicion of complete obstruction of left main bronchus. The distal part of left main bronchus was completely obstructed by multiple polypoid masses. The mass was removed with a laser incision, and a foreign body surrounded by mucus was found. It was removed with a forceps. At 2 days after the removal, the subcutaneous emphysema was improved, and the chest CT taken 14 days later showed stenosis but no obstruction.
Abdomen ; Bronchi* ; Bronchoscopy ; Child, Preschool ; Constriction, Pathologic ; Cough ; Diet ; Emergencies ; Fever ; Foreign Bodies* ; Humans ; Infant ; Infant, Newborn ; Lung ; Male ; Mediastinal Emphysema* ; Mucus ; Neck ; Pulmonary Atelectasis ; Retropneumoperitoneum* ; Spasms, Infantile ; Subcutaneous Emphysema ; Surgical Instruments ; Thorax ; Tomography, X-Ray Computed

Colonoscopy is a commonly performed endoscopic procedure. Although it is generally considered to be safe, serious complications, such as colorectal perforation, can occur. Most colonic perforations are intraperitoneal and cause pneumoperitoneum with acute abdominal pain as the initial symptom. However, extraperitoneal perforations with pneumoretroperitoneum may happen, albeit rarely, with atypical initial symptoms. We report a rare case of rectosigmoid perforation occurring after diagnostic colonoscopy that developed into pneumoretroperitoneum, pneumomediastinum, pneumothorax, and subcutaneous emphysema, with a change in voice and neck swelling as the initial symptoms. The patient was successfully treated with endoscopic closure of the perforation and conservative management.
Abdominal Pain ; Colon ; Colonoscopy* ; Humans ; Mediastinal Emphysema* ; Neck ; Pneumoperitoneum ; Pneumothorax* ; Retropneumoperitoneum* ; Subcutaneous Emphysema* ; Voice

Transanal endoscopic microsurgery is considered a safe, appropriate, and minimally invasive approach, and complications after endoscopic microsurgery are rare. We report a case of sepsis and pneumoretroperitoneum after resection of a rectal lateral spreading tumor. The patient presented with rectal mucous discharge. Colonoscopy revealed a rectal lateral spreading tumor. The patient underwent an endoscopic transanal resection of the lesion. He presented with sepsis of the abdominal focus, and imaging tests revealed pneumoretroperitoneum. A new surgical intervention was performed with a loop colostomy. Despite the existence of other reports on pneumoretroperitoneum after transanal endoscopic microsurgery, what draws attention to this case is the association with sepsis.
Colonoscopy ; Colostomy ; Humans ; Microsurgery ; Retropneumoperitoneum* ; Sepsis* ; Transanal Endoscopic Microsurgery

An endoscopic mucosal resection (EMR) is an effective and safe therapeutic technique for treating a patient with a laterally-spreading tumor (LST). Colonoscopic-procedure-related complications are noted to be about 2.8% worldwide, and a perforation is the most common. Most colon perforations cause pneumoperitoneum. However, a perforation within the retroperitoneal portion of the colon (rectum and some of sigmoid colon) may cause an extraperitoneal perforation, and the leaking free air may induce pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema, depending on the amount of discharged air. Herein, we present the case of a patient with an extraperitoneal colon microperforation which manifested as pneumoretroperitoneum, pneumomediastinum, and subcutaneous emphysema after an EMR for a sigmoid LST, which was successfully treated with medical treatment and endoscopic clipping.
Colon ; Colon, Sigmoid ; Colonoscopy ; Humans ; Mediastinal Emphysema* ; Pneumoperitoneum ; Retropneumoperitoneum* ; Subcutaneous Emphysema*

We describe an unusual case of delayed retropneumoperitoneum caused by a deep vaginal laceration as a result trauma from a water jet in a fountain. A 7-year-old premenarcheal girl presented to the emergency department after experiencing an injury from a water jet at a fountain park. Initially, the patient's vital sign and perineum were within normal range. Because the patient's vital signs became unstable 12 hours after vaginal injury, we carried out abdomino-pelvic computed tomography resulting in retropneumoperitoneum. Arterial bleeding from vaginal lateral wall was founded and controlled by electrocoagulation. No damage to the rectum was laparoscopically confirmed. A diagnostic laparoscopy, not laparotomy, should be considered in cases of retropneumoperitoneum with an ambiguous cause first.
Child* ; Electrocoagulation ; Emergency Service, Hospital ; Female* ; Hemorrhage ; Humans ; Lacerations* ; Laparoscopy ; Laparotomy ; Perineum ; Rectum ; Reference Values ; Retropneumoperitoneum* ; Vagina ; Vital Signs ; Water

BACKGROUNDS/AIMS: Pneumatosis intestinalis (PI) is a condition in which multiple gas-filled mural cysts develop in the gastrointestinal tract. Although its exact etiology remains obscure, PI is rarely observed in liver transplant (LT) recipients. METHODS: In 317 cases of adult living donor LT (LDLT) performed during 2011, PI developed in three patients during the 3 year follow-up. RESULTS: Of these three patients, the two who demonstrated PI at 6 weeks and 2 months after LT, respectively, were asymptomatic and showed no signs of secondary complications. Diagnosis was made incidentally using abdominal radiographs and computed tomography (CT) scans. PI was identified in the right ascending colon with concomitant pneumoperitoneum. These two patients received supportive care and maintained a regular diet. Follow-up CT scans demonstrated spontaneous resolution of PI with no complications. The third patient was admitted to the emergency room 30 months after LDLT. His symptoms included poor oral intake and intermittent abdominal pain with no passage of gas. Abdominal radiography and CT scans demonstrated PI in the entire small bowel, with small bowel dilatation, pneumoperitoneum, and pneumoretroperitoneum, but no peritonitis. Physical examination revealed abdominal distension but no tenderness or rebound tenderness. After 1 week of conservative treatment, including bowel rest and antibiotics therapy, PI and pneumoperitoneum resolved spontaneously without complications. CONCLUSIONS: We suggest that adult LDLT recipients who develop asymptomatic or symptomatic PI with no signs of secondary complications can be successfully managed with conservative treatment.
Abdominal Pain ; Adult* ; Anti-Bacterial Agents ; Colon, Ascending ; Diagnosis ; Diet ; Dilatation ; Emergency Service, Hospital ; Follow-Up Studies ; Gastrointestinal Tract ; Humans ; Liver ; Liver Transplantation* ; Living Donors* ; Peritonitis ; Physical Examination ; Pneumoperitoneum ; Radiography, Abdominal ; Retropneumoperitoneum ; Tomography, X-Ray Computed

Endoscopic submucosal dissection (ESD) is widely accepted as an alternative treatment to surgical resection for gastric neoplastic lesions. Among the complications of gastric ESD, perforation is usually manifested as a pneumoperitoneum. Here, we report a patient with a right-sided pneumothorax, pneumoperitoneum, and pneumoretroperitoneum as complications of gastric ESD. The patient recovered without further complications using conservative treatment, including endoscopic clipping, nasogastric drainage, and insertion of a chest tube.
Chest Tubes ; Drainage ; Endoscopy ; Humans ; Pneumoperitoneum ; Pneumothorax* ; Retropneumoperitoneum

BACKGROUNDThe ability of pneumoperitoneum in laparoscopic surgery to promote proliferation and metastasis of colorectal cancer has become a focus of research in the field of minimally invasive surgery. The aim of this research was to investigate the effect of CO2 pneumoperitoneum under different pressures and exposed times on the expression of chemokine receptors in colorectal carcinoma cells.

METHODSWe constructed an in vitro pneumoperitoneum model. SW480 colon carcinoma cells were exposed to CO2 pneumoperitoneum under different pressures (6, 9, 12, and 15 mmHg) for 1, 2, and 4 hours. These cells were then cultivated under the same conditions as normal SW480 colon carcinoma cells without CO2 pneumoperitoneum (control group), treated at 37°C, and 5% CO2. The expression of the chemokine receptors CXC receptor 4 (CXCR4) and chemokine C receptor 7 (CCR7) was detected by immunocytochemistry and reverse transcriptase polymerase chain reaction after being cultivated for 0, 24, 48, and 72 hours.

RESULTSImmunocytochemistry showed that CXCR4 expression in SW480 cells was significantly decreased in the 6, 9, 12, and 15 mmHg CO2 pneumoperitoneum-treated groups for the same exposure times compared with controls (P < 0.05). CCR7 expression in SW480 cells was significantly decreased in the 12 and 15 mmHg CO2 pneumoperitoneum-treated groups compared with controls (P < 0.05). CXCR4 and CCR7 expression increased up to the level of the control group after 24 and 48 hours (P > 0.05). If the CO2 pneumoperitoneum pressure increased, CXCR4 and CCR7 expression decreased at all exposure times. If the CO2 pneumoperitoneum exposure time prolonged, there were no significant differences in CXCR4 and CCR7 expression under the same pressure. Under all exposure times, CXCR4 and CCR7 mRNA expression was significantly decreased in the 6, 9, 12, and 15 mmHg CO2 pneumoperitoneum-treated groups (P < 0.05) compared with controls, and it increased up to the level of controls after being cultivated for 48 hours (P > 0.05). If the CO2 pneumoperitoneum pressure increased (with all exposure times) and exposure time prolonged (under the same pressure), there were no significant differences in CXCR4 and CCR7 expression.

CONCLUSIONSCXCR4 and CCR7 expression is temporarily affected after continuous CO2 pneumoperitoneum treatment. The high pressure of CO2 pneumoperitoneum plays an important role in suppressing the expression of these chemokine receptors. Different lengths of time of exposure to a CO2 pneumoperitoneum-like environment do not change CXCR4 and CCR7 expression.

Carbon Dioxide ; adverse effects ; Cell Line, Tumor ; Colorectal Neoplasms ; metabolism ; Humans ; Receptors, CCR7 ; metabolism ; Receptors, CXCR4 ; metabolism ; Retropneumoperitoneum ; complications ; metabolism

Procedure for prolapsed hemorrhoid (PPH) is well recognized alternative to the traditional hemorrhoidectomy, and is associated with reduced pain and earlier return to normal activity. Over the past decade, there have been reports of severe life-threatening complications after a PPH, although the incidence is very low. Rectal perforation due to staple-line dehiscence is one of the serious complications that can cause severe pelvic sepsis or a pneumoretroperitoneum. Here, the first Korean case of a pneumoretroperitoneum due to staple-line dehiscence is described.
Hemorrhoidectomy ; Hemorrhoids* ; Incidence ; Retropneumoperitoneum* ; Sepsis

No abstract available.
Colon* ; Colonoscopy* ; Mediastinal Emphysema* ; Pneumoperitoneum* ; Retropneumoperitoneum* ; Subcutaneous Emphysema*