Head and neck subcutaneous emphysema, a rare complication of iatrogenic perforation during colonoscopy: management review of reported cases from 2000-2016.

INTRODUCTION

Subcutaneous face and neck emphysema secondary to colonic perforation is a rare complication of colonoscopy. Presentation may be complicated by pneumothorax and/or respiratory distress. Evidence limited to case studies. Therefore, no management consensus of these rarely reported cases exists.

METHODS

All cases published on PubMed between 1 January 2000-1 November 2016 reporting subcutaneous face and/or neck emphysema after colonoscopy are included. Management is discussed with trends identified. We report a case of a patient undergoing routine polypectomy who developed subcutaneous emphysema of the face, neck and thorax with a pneumothorax and pneumoretroperitoneum.

RESULTS

37 cases were found (mean age = 64.1 ± 15.09 years). The majority (n = 24) were managed non-operatively. Conservative and operative management had mean inpatient stays of 7.6 ± 4.65 and 19.5 +/- 21.62 days respectively. Sixteen cases had a concomitant pneumothorax with nine (56.3%) requiring decompression. No mortalities occurred.

CONCLUSION

An understanding of anatomy heightens awareness of the rare complication of face and/or neck surgical emphysema, secondary to pneumoretroperitoneum and pneumothorax, after perforation of the colon during endoscopy. Management remains controversial with expectant conservative bowel rest with antibiotics and operative intervention described. Conservative management had a shorter inpatient stay and was more common in younger patients.