Abstract
An 89-year-old man, who was under observation for a several-week history of a small amount of melena, was referred to our hospital when he developed abdominal pain and nausea of sudden onset. Physical examination revealed subcutaneous emphysema extending from the cervical to the femoral region, more pronounced on the left side of the body. The abdomen was distended and there were signs of tenderness and peritoneal irritation over the entire abdomen. A plain x-ray of the abdomen revealed a markedly dilated sigmoid colon. Based on a suspicion of volvulus of the sigmoid colon, emergency operation was conducted. The sigmoid colon was found to be markedly emphysematous, however, there was no evidence of volvulus or perforation to the peritoneal cavity. Examination of specimens collected at surgery revealed a deep ulcer in the sigmoid colon, extending up to the subserosal layer. These observations suggest that the pressure in the intestinal tract was probably elevated because of occlusive ileus due to a hard scatoma (stools) and that the gas from the lumen diffused through the ulceration to the subserosal layer, and then on to the subcutaneous tissue. The present case was thus considered to show a very uncommon presentation.
