A 71-year-old male who had previously undergone surgery in another center for a villous adenoma of the rectum, by transanal excision, with pathological results of low grade dysplasia.
In subsequent controls he reported mucous secretion with feces without rectal bleeding or altered intestinal rhythm.
Rectal examination showed a tumor from 4 to 8 cm from the anal margin in the right lateral face, occupying half of the circumference.
The patient reported the existence of a polyp from the pectin line up to 7 cm of anal margin, with histological diagnosis of villous adenoma with low grade dysplasia.
Computed tomography (CT) with parietal fibrosis revealed no tumour-pelvic, pathological findings; endorectal ultrasound and magnetic resonance imaging reported a pathological tumour2N that interpreted the muscle layer as a postsurgical lymph node.
With the diagnosis of recurrent villous adenoma it was decided to surgically intervene the patient in our unit by means of TEM.
Exeresis of the adenoma and total thickness of the right lateral rectal wall with partial suture of the defect was performed.
The pathological study of the specimen reported a villous adenoma with low grade dysplasia and surgical margins of resection without lesions.
On the first postoperative day, the patient presented discomfort and increased cervical volume, without dyspnea or other symptoms.
On physical examination, a bilateral cervical crepitation and a slightly distended abdomen were observed, but not painful.
Chest and abdominal X-rays showed subcutaneous cervical emphysema, pneumomediastinum and pneumoperitoneum.
Since the patient was stable, a CT scan confirmed the presence of air in the peritoneal cavity without other pathological findings.
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After establishing digestive rest and intravenous antibiotic therapy, the clinical evolution of the patient was favorable, the emphysema resolved progressively and was discharged on the tenth day after surgery.
