Postpartum pneumomediastinum manifested by surgical emphysema. Should we always worry about underlying oesophageal rupture?

Spontaneous pneumomediastinum during labour is a rare, usually benign and self-limiting condition. It often presents with chest or neck pain and surgical emphysema. The latter sign is easy to demonstrate but often missed during clinical assessment if the condition is not included in the differential diagnosis of chest pain and dyspnoea in peripartum. The authors describe a case of 20-year-old primigravida who developed surgical emphysema following prolonged vaginal delivery. The chest x-ray revealed pneumomediastinum, and small left apical pneumothorax. She was investigated with CT of the chest and contrast swallow, both of which excluded oesophageal perforation. The management was conservative and she made a complete recovery. Spontaneous oesophageal rupture is a potential cause of pneumomediastinum and leads to high morbidity and mortality if not diagnosed early. However, it is extremely uncommon in labour, especially without a preceding history of vomiting. Unless a strong clinical suspicious exists, routine investigations and or treatment of suspected oesophageal perforation are unnecessary.