Case Report Korean J Anesthesiol 2012 May 62(5): 488-492 http://dx.doi.org/10.4097/kjae.2012.62.5.488 Bilateral pneumothoraces, pneumomediastinum, pneum- operitoneum, pneumoretroperitoneum, and subcutaneous emphysema after percutaneous tracheostomy -A case report- Won Ho Kim1, and Byoung Ho Kim2 Department of Anesthesiology and Pain Medicine, 1Samsung Seoul Hospital, Samsung Medical Center, Sungkyunkwan University School of Medicine, 2Seoul Medical Center, Seoul, Korea We report a rare case of a 72-year-old female who developed extensive subcutaneous emphysema, bilateral pneumo- thoraces, pneumomediastinum, pneumoperitoneum, and pneumoretroperitoneum after a percutaneous dilatational tracheostomy. The patient’s T-cannula was accidentally connected to the oxygen line with a non-perforated connector. The patient rapidly developed respiratory insufficiency and subcutaneous emphysema in the neck and both shoulders. The bilateral pneumothoraces were managed using a chest tube. CT scans of the chest, abdomen, and pelvis revealed an extensive distribution of air throughout the chest and abdomen. The patient was treated successfully with supportive care. This case illustrates the rare occurrence of air passing into multiple body compartments, highlighting the potentially serious complications of a tracheostomy and the importance of intensive care during the recovery period. (Korean J Anesthesiol 2012; 62: 488-492) Key Words: Pneumomediastinum, Pneumoperitoneum, Pneumoretroperitoneum, Pneumothorax, Subcutaneous emphysema, Surgical tracheostomy. Pe rc u t a n e o u s t ra c h e o s t o my , a c o m m o n s u r g i c a l procedure in the field of otolaryngology, is associated with complications, such as bleeding, infection, subcutaneous emphysema, pneumothorax, recurrent laryngeal nerve injury and tracheal ring fracture [1]. We encountered an rare case of extensive subcutaneous emphysema, bilateral pneumo- thoraces, pneumomediastinum, pneumoperitoneum, and pneumoretroperitoneum in a single individual caused by the accidental insufflation of oxygen through the tracheostomy tube site with a non-perforated connector. This case illustrates the Received: March 28, 2011. Revised: 1st, April 10, 2011; 2nd, May 14, 2011. Accepted: May 23, 2011. Corresponding author: Won Ho Kim, M.D., Department of Anesthesiology and Pain Medicine, Samsung Seoul Hospital, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Irwon-dong, Gangnam-gu, Seoul 135-710, Korea. Tel: 82-2-3410-2470, Fax: 82-2- 3410-6626, E-mail: bullet57@naver.com CC This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright ⓒ the Korean Society of Anesthesiologists, 2012 www.ekja.org