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Facial subcutaneous emphysema due to rectum injury after pelvic fracture
  1. Joost H Kuipers,
  2. P Koen Bos and
  3. Duncan E Meuffels
  1. Department of Orthopaedic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Joost H Kuipers; joostk{at}


A 35-year old dockworker sustained a pelvic injury when he was caught by a large loading clamshell grab. Primary survey revealed an open book pelvic fracture with soft tissue defects of the left thigh and groin. CT scanning of the thorax and abdomen did not reveal significant additional injuries. Partly due to patient’s haemodynamical instability, osteosynthesis of the pelvic fracture was performed immediately after resuscitation, whereby the severely contaminated wound of the thigh was debrided and irrigated. The following days, progressive facial subcutaneous emphysema developed, but patient remained clinically stable. Several specialists were consulted, but did not find a cause. At day 7, a second surgery was planned to treat a pelvic surgical wound infection. Unexpectedly, we found faecal contamination in the pelvic surgical wound. The consulted gastro/intestinal-surgeon performed a laparoscopic colostomy for a rectal laceration. Awareness for bowel injuries with open pelvic fracture should be high, also when subcutaneous emphysema is found remotely.

  • orthopaedic and trauma surgery
  • pneumomediastinum
  • orthopaedics
  • trauma
  • gastrointestinal surgery

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  • Contributors JK, KB and DEM were involved in conceptualisation, writing and critically revising the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.