Abstract
Air in the subcutaneous tissues, commonly described as subcutaneous emphysema, creates a distinctive clinical sign on palpation. Usually, this results from an air leak from the airways or lungs forcing air into the mediastinum and in between soft tissue planes. This review aims to draw attention to bowel perforations below the diaphragm as an alternative origin of subcutaneous emphysema. Reference to numerous case reports illustrate a variety of presentations and causes. Delayed recognition and treatment of bowel perforation can have serious, potentially life-threatening, consequences. Patients presenting with subcutaneous emphysema without an obvious intra-thoracic cause should lead the clinician to consider acute intra-abdominal pathology, such as bowel perforation, especially after endoscopic procedures. Early recognition of this phenomenon can be life saving.