ABSTRACT Background: An elderly lady presented with dyspnoea due to congestive cardiac failure. She was subsequently noted to have cervi-cal subcutaneous emphysema. Post mortem identified an occult perforation of a sigmoid diverticulum. Cervical subcutaneous em-physema 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 cer-vical subcutaneous emphysema. In this patient, signs and symptoms of peritonism were also late in onset and the location of the per-foration was not found despite high resolution imaging being used.
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