Pneumoperitoneum, pneumoretroperitoneum, pneumomediastinum and extensive subcutaneous emphysema in a patient with ulcerative colitis: A case report

•Spontaneous non-iatrogenic pneumo-mediastinum and subcutaneous emphysema is a rare presentation.•It is usually associated with invasive GI procedures.•The patient presented with multiple spontaneous perforation leading to extensive spread of free air along fascial planes.

IntroductionPneumo-mediastinum and subcutaneous emphysema are rare presentations of lower gastrointestinal tract perforation.Presentation of caseWe are presenting the case of a middle aged man diagnosed with UC who presented with dyspnea and subcutaneous emphysema, attributed to multiple perforations including the stomach and colon.Case discussionPatients with ulcerative colitis (UC) are at an increased risk of perforations due to friability of colonic mucosa given the chronic inflammation and relapsing flares. Chronic use of steroids further predisposes to stress ulcers. These pathologies sometimes coexist and identification of each is crucial for the appropriate treatment plan.ConclusionThe case allows for a learning opportunity focusing on coexisting pathologies which may be differentiated based on anatomical knowledge and patient presentation.