Subcutaneous Emphysema, Pneumothorax, Pneumomediastinum, and Pneumoperitoneum During Cystoscopy: A Case Report; [شرازگیدرومزا،سکاروتومونپنتسایدمومونپونئوتیرپومونپردنیحماجنایپوکسوتسیس] Publisher



Sis A A ; Yazdi S A M
Source: Avicenna Journal of Clinical Medicine Published:2026

Abstract

Background: Bladder perforation is a well-recognized but uncommon complication of cystoscopy and may occur either intraperitoneal or extraperitoneal. Most perforations are small and often asymptomatic; therefore, they may not require intervention and frequently remain undiagnosed until advanced imaging is performed. These complications typically occur during diagnostic or therapeutic procedures, such as biopsy or resection of bladder lesions. Air leakage following bladder perforation can spread through fascial planes, resulting in rare but significant complications, including subcutaneous emphysema, pneumothorax, pneumoperitoneum, and pneumomediastinum. Case Presentation: A 67-year-old man developed sudden and progressive subcutaneous emphysema during cystoscopy and biopsy of a suspicious bladder mass. The emphysema initially appeared in the scrotum and lower abdomen, then rapidly extended to the neck. The procedure was immediately terminated, and the patient underwent close monitoring. He remained hemodynamically stable throughout the course. Contrast-enhanced computed tomography scan of the chest, abdomen, and pelvis revealed extensive subcutaneous emphysema, pneumothorax, pneumomediastinum, pneumoperitoneum, and a defect in the bladder dome consistent with bladder perforation. Consequently, conservative management was initiated, including placement of a Foley catheter for continuous bladder drainage, administration of broad-spectrum intravenous antibiotics, and close hemodynamic observation. The subcutaneous emphysema gradually regressed and completely resolved by the fifth day. Conclusion: Air leakage through fascial planes leading to subcutaneous emphysema, pneumothorax, pneumomediastinum, and pneumoperitoneum may occur following bladder perforation during cystoscopy. In hemodynamically stable patients, these complications can be successfully managed with conservative management. This case study aimed to highlight that even extensive air-related complications do not necessarily mandate surgical intervention. © 2026 Avicenna Journal of Clinical Medicine.