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An 80-year-old man with multiple medical problems underwent a colonoscopy, which was performed to determine the cause of anemia. During the colonoscopy, he reported abdominal discomfort, and profound abdominal distention developed. When the endoscope was withdrawn, a sigmoid diverticulum with a ragged lining was noted to be bleeding — a finding that suggested possible perforation. A clip was placed across the diverticulum, and epinephrine was injected into the area to control the bleeding. Immediately after the procedure, scrotal enlargement and crepitance were noted, and diffuse subcutaneous air subsequently accumulated over the entire trunk, legs, and arms. Radiographs showed pneumoperitoneum (Panel A, arrow), pneumomediastinum (Panel A, arrowhead), and diffuse subcutaneous air over the trunk (Panels A and B, curved arrows) and scrotum and down the legs (Panels C and D, arrows). The patient was admitted and given antibiotic agents. He recovered fully without additional intervention.
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