Abstract / Summary
BackgroundEndoscopic submucosal dissection (ESD) has become a widely accepted technique for en bloc resection of colorectal laterally spreading tumors (LSTs). Although the procedure is generally considered safe, complications including bleeding and perforation may occur. The simultaneous development of pneumothorax, pneumomediastinum, pneumoperitoneum, and extensive subcutaneous emphysema following colorectal ESD represents an exceptionally rare but potentially serious adverse event.Case summaryA 56-year-old female patient underwent ESD for a granular-type LST measuring 8 mm × 20 mm located in the ascending colon. The procedure was performed under general anesthesia with tracheal intubation and carbon dioxide insufflation. Complete en bloc resection was achieved, and the post-ESD mucosal defect was closed with 16 titanium clips. Approximately 3 h after the procedure, the patient developed progressive neck swelling without respiratory distress or chest pain. Computed tomography (CT) revealed a small amount of pneumothorax on the right side and fluid pneumothorax on the left side (lung compression <10%), extensive subcutaneous emphysema involving the neck, chest wall, and right proximal thigh, pneumomediastinum, and pneumoperitoneum. The patient was managed conservatively with high-flow nasal cannula oxygen, bowel rest, intravenous antibiotics, and proton pump inhibitor therapy. Serial imaging demonstrated gradual resolution of the ectopic gas collections. The patient recovered uneventfully and was discharged on postoperative day 7.ConclusionThis case demonstrates that extensive gas extravasation involving multiple body compartments can occur as a rare complication of colorectal ESD, particularly when procedures are performed in the retroperitoneal portion of the colon under general anesthesia with positive pressure ventilation. Prompt recognition, timely CT evaluation, and conservative management in hemodynamically stable patients can lead to favorable outcomes without the need for surgical intervention.