Neonatal Subcutaneous Emphysema Secondary to Chest Tube Placement Using the Trocar Technique: A Case Report.

Subcutaneous emphysema is a type of air leak in which air accumulates within the subcutaneous layer of the skin underneath the dermal layers. The accumulation of air can be seen on imaging in relevant body areas such as the abdomen, chest, face, or neck. During physical examination, crepitus, the sensation or sound of crackling upon palpation, is the most common associated finding. Various causes for subcutaneous emphysema exist, with one such cause being thoracostomy or chest tube placement. The trocar technique, in particular, has been associated with greater complications when compared to other techniques. Here, we present a case of subcutaneous emphysema in a neonate occurring after placement of a chest tube using the trocar technique. At this time, much of the knowledge regarding subcutaneous emphysema related to chest tube placement is in the adult population. Clinicians should be aware of this complication in neonates as the body of knowledge regarding this topic continues to grow.

Necrotizing Fasciitis of the Abdominal Wall Secondary to Complicated Appendicitis: A Case Report.

Acute appendicitis is one of the most common surgical emergencies worldwide. Many complications can occur secondary to complicated appendicitis including abscess formation, gangrene, sepsis, and perforation, rarely, leading to abdominal wall necrotizing fasciitis. The incidence of necrotizing fasciitis as a complication of ruptured appendicitis is extremely uncommon. The formation of an enterocutaneous fistula leading to this complication further emphasizes the rarity of such occurrence with few cases reported in the literature. Herein, we present a case of abdominal wall necrotizing fasciitis in a 72-year-old female presenting to the local emergency room with complaints of severe suprapubic abdominal pain associated with abdominal distension and acute onset foul-smelling drainage. Physical exam was significant for suprapubic and right lower quadrant abdominal tenderness with associated large indurated tender lesion and purulent weeping with large ecchymosis. Abdominal computed tomography (CT) revealed extensive subcutaneous emphysema, a large cavity with layering fluid extending into the peritoneal space, and a possible fistula formation between the intra-abdominal cavity and subcutaneous tissue. Following the diagnosis of probable necrotizing fasciitis secondary to fistula formation, the patient underwent emergent exploratory laparotomy and extensive debridement of necrotic tissue. In this report, we take the opportunity to highlight the importance of promptly recognizing and treating this uncommon complication and maintaining a high level of suspicion to prevent life-threatening consequences.