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Pneumopericardium, pneumomediastinum, pneumoretroperitoneum and surgical emphysema secondary to a duodenal perforation post-endoscopic retrograde cholangiopancreatography
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  1. Joshua Paul Harvey
  1. Department of General Surgery, Medway Maritime Hospital, Gillingham, Kent, UK
  1. Correspondence to Dr Joshua Paul Harvey, harveyjoshua90{at}gmail.com

https://doi.org/10.1136/bcr-2015-209920

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    Description

    A 46-year-old woman presented with severe upper abdominal pain and vomiting 12 h post-endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy for choledocholithiasis. The patient also described a sensation of ‘crackling in the neck’ on head rotation. On examination, the patient was stable and afebrile, and had pain in the right hypochondriac region. She had subcutaneous crepitations in the right side of the neck and chest. Blood results showed white cell count 15.5×109/L, C reactive protein 13.7 mg/L, amylase 55 IU/L, alanine transaminase 46 IU/L and alkaline phosphatase 300 IU/L; all other blood tests were normal.

    An erect chest radiograph demonstrated a pneumopericardium, pneumomediastinum and surgical emphysema in the root of the neck (figure 1). …

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