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Diverticular perforation: an unusual cause of subcutaneous emphysema
  1. Thomas Wiles1,
  2. Rebecca Mullett2,
  3. Michael Chadwick3
  1. 1Emergency Department, Leighton Hospital, Crewe, UK
  2. 2Radiology Department, Whiston Hospital, Prescot, Merseyside, UK
  3. 3Colorectal Surgery Department, Whiston Hospital, Prescot, Merseyside, UK
  1. Correspondence to Dr Thomas Wiles, Emergency Department, Leighton Hospital, Middlewich Road, Crewe, CW1 4QJ, UK; tomwiles{at}doctors.org.uk

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An 81-year-old woman with stage 4 chronic kidney disease (focal segmental glomerulosclerosis) requiring steroids and immunosuppression with mycophenolate mofetil presented with left iliac fossa (LIF) pain, anorexia and rectal bleeding with mucus. Examination and investigations revealed no pyrexia, LIF tenderness, supraclavicular subcutaneous emphysema or leucocytopenia. An erect chest x-ray (figure 1) ruled out pneumoperitoneum but demonstrated extensive supraclavicular subcutaneous emphysema and pneumomediastinum. No pneumothorax was present.

Figure 1

Erect …

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