Cervical Subcutaneous Emphysema; Sequelae from Occult Perforation of Sigmoid Diverticulum

Background: An elderly lady presented with dyspnoea due to congestive cardiac failure. She was subsequently noted to have cervical subcutaneous emphysema. Post mortem identified an occult perforation of a sigmoid diverticulum. Cervical subcutaneous emphysema is a recognised complication of gastrointestinal perforation; however, it is normally associated with upper gastrointestinal pathology, procedure related or sequel of existing disease. Summary: A perforated sigmoid diverticulum is a very rare cause of cervical subcutaneous emphysema. In this patient, signs and symptoms of peritonism were also late in onset and the location of the perforation was not found despite high resolution imaging being used.