A RARE CASE OF COLONIC PERFORATION PRESENTING AS SUBCUTANEOUS EMPHYSEMA OF LOWER CHEST, ANTERIOR ABDOMINAL WALL AND SCROTUM

A 30-yr-old man presented with history of not passing motion and flatus for 4 days, painful abdominal distention and vomiting for 1 day with extensive subcutaneous emphysema of lower chest, anterior abdominal wall and scrotal wall. X ray chest PA view revealed no pneumothorax. X ray abdomen demonstrates multiple air shadows on right side of abdomen with dilated small bowel loops with no gas under diaphragm. CECT scan abdomen showed the outline of ascending colon is ill defined with large pockets of air surrounding the ascending colon with extensive pneumoperitoneum. Diagnoses of retroperitoneal colonic perforation were made. Exploratory laparotomy revealed large cecal perforation with retroperitoneal ascending colon perforation. The parietal peritoneum on right lumbar and right iliac fossa was sloughed. Right hemicolectomy with end ileostomy was done. Despite multiple operations the patient died 20 days after admission due to multiple organ failure. Patient presenting with subcutaneous emphysema of abdomen and scrotum without an obvious thoracic course should be scrutinized for retroperitoneal hollow viscus perforation to achieve successful early management.