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Vomiting-induced surgical emphysema and pneumomediastinum: a self-remitting or life-threatening condition?

Authors
  • Dyer, James
  • Jones, Steve
Type
Published Article
Journal
BMJ Case Reports
Publisher
BMJ
Publication Date
Jan 01, 2011
Volume
2011
Identifiers
DOI: 10.1136/bcr.12.2010.3608
PMID: 22707374
Source
Medline
License
Unknown

Abstract

A previously well 18-year-old male presented with a 3-day history of vomiting, abdominal pain and increasing neck swelling. X-rays demonstrated both pneumomediastinum and cervical surgical emphysema and initial efforts were centred upon excluding Boerhaave syndrome (vomiting-induced oesophageal rupture). Upper gastrointestinal endoscopy and contrast CT scans excluded breech of the oesophagus but did, however, confirm dilated small bowel. Over the days, his condition did not improve, repeat CT demonstrated worsening small bowel dilatation and he eventually underwent laparotomy on day 5 of his admission. This revealed a high-grade obstruction in the right iliac fossa (presumably from a previous appendicectomy). Following adhesiolysis, he made a full recovery from both small bowel obstruction and surgical emphysema.

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