PNEUMOMEDIASTINUM FOLLOWING TRANSANAL EXCISION OF A RECTAL TUMOR

A 45 year old male underwent full thickness transanal excision of a re current rectal villous adenoma. On the evening of surgery he developed an unexplained fever of 38.9-degrees-C. Plain X-rays revealed a signi ficant pneumomediastinum and pneumoretroperitoneum. This was thought t o be due to passage of intrarectal air into the mesorectum and extrava sation along tissue planes. The patient was managed with restricted fl uids by mouth, an antidiarrhoeal agent, intravenous antibiotics, and f requent clinical and radiological observations. During the following 4 8 hours the fever settled and the pneumomediastinum resolved by the te nth postoperative day. Sigmoidoscopic examination at this time showed a healing rectal wound. This case illustrates a potential consequence of pelvic surgery and emphasizes the extent of the visceral space that exists as a continuum between the pelvis, abdomen, thorax and neck. T his is an unusual complication with a dramatic radiological appearance , but one that can be managed successfully with expectation of a compl etely benign course.