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Case Report
Massive pneumoperitoneum and subcutaneous emphysema after transanal resection of a rectal tumor: Case report and comprehensive review of the literature
1 General Surgery, Head of the Department of General Surgery and Digestive System, Hospital Quironsalud Torrevieja, Quironsalud Health Group, Partida de la Loma, S/N, Torrevieja, Alicante 03184, Spain
2 Medical Student, Chicago Medical School, Rosalind Franklin University of Medicine and Sciences, 3333 N Green Bay Rd, North Chicago, IL 60064, USA
Address correspondence to:
Marie Stephanie Nunez Duarte
Chicago Medical School, Rosalind Franklin University of Medicine and Sciences, 3333 N Green Bay Rd, North Chicago, IL 60064,
USA
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Article ID: 100154Z12PB2025
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Boix PB, Duarte MSN, Dieter A, Silver R. Massive pneumoperitoneum and subcutaneous emphysema after transanal resection of a rectal tumor: Case report and comprehensive review of the literature. J Case Rep Images Surg 2025;11(1):31–36.ABSTRACT
Introduction: Transanal excision (TAE) is increasingly used to treat malignant polyps and early-stage rectal tumors due to its minimally invasive nature, which facilitates quicker recovery and fewer postoperative complications compared to traditional abdominal approaches. However, while TAE is generally safe, rare complications—such as pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema—can occur, likely related to insufflation pressures during the procedure.
Case Report: We report the case of a 72-year-old woman who underwent TAE for a rectal adenocarcinoma. The procedure was completed without evidence of intraoperative perforation. Nonetheless, on postoperative day one, the patient developed respiratory distress, fever, and abdominal discomfort. Imaging studies revealed the presence of air in the retroperitoneum and soft tissues. She was managed conservatively with intravenous antibiotics and supportive care, leading to full recovery by day four without the need for additional surgical intervention.
Conclusion: This case underscores that, although TAE offers significant benefits in terms of reduced morbidity, clinicians should remain vigilant for rare but dramatic complications. In the absence of peritonitis or sepsis, conservative management appears effective, supporting the continued use of TAE as a safe and minimally invasive option for rectal tumor excision.
Keywords: Pneumoperitoneum, Pneumoretroperitoneum, Rectal adenocarcinoma, Subcutaneous emphysema, Transanal excision
SUPPORTING INFORMATION
Author Contributions
P Bretcha Boix - Substantial contributions to conception and design, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Marie Stephanie Nunez Duarte - Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
A Dieter - Acquisition of data, Analysis of data, Drafting the article, Final approval of the version to be published
R Silver - Acquisition of data, Analysis of data, Drafting the article, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2025 Bretcha Boix et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
