Abstract
A 63-year-old man with no past history of chest injury presented with abdominal pain and constipation. When he was referred to our hospital with a diagnosis of ileus there was abdominal distension but he had neither chest pain nor dyspnea. Abdominal CT scans demonstrated obstruction of the sigmoid colon, while chest CT scans showed pneumomediastinum but indicated no evidence of esophageal rupture. The patient underwent immediate colostomy, and the pneumomediastinum disappeared during this period. Two months later, he underwent recto-sigmoidectomy and partial hepatectomy sequentially, as further examinations indicated cancer of the sigmoid colon and rectum with hepatic metastasis. Adjuvant chemotherapy was conducted over two and a half years due to recurrent cancer. After several courses of the chemotherapy, he was hospitalized due to acute respiratory failure with high fever. He was treated by the mechanical ventilation and the administration of corticosteroid, which led to temporal improvement. However, seven days after mechanical ventilation, the X-rays demonstrated recurrence of pneumomediastinum, which subsequently disappeared after 10 days without any treatments, despite a continued use of mechanical ventilation. The patient died from respiratory failure two months after re-admission.
We herein report a rare case of recurrent pneumomediastinum after a long interval, together with bibliographic comments including the mechanisms of occurrence as well as characteristics of clinical course of pneumomediastinum.
