Widespread surgical emphysema following trivial injury to the hand.

A 23-year-old glazer presented to the A&E department with pain in his left arm following a 2 mm puncture injury to his left thenar eminence. Examination showed crepitus throughout the arm and over the chest wall. Plain X-rays confirmed extensive surgical emphysema but no evidence of pneumothorax. Clinical observations and laboratory markers for infection were normal. The patient was prescribed broad spectrum antibiotics for presumed gas-producing organism infection. After 24 h cultures returned negative and no other signs of infection were detected. Treatment was discontinued and the patient was allowed home. Several days later he experienced severe diarrhoea and as a result required time off work. No cause was found on investigation. We postulate a benign aetiology for the surgical emphysema in this case. In future it may be possible to recognise benign surgical emphysema at presentation and avoid prescribing unnecessary antibiotics. 2014 BMJ Publishing Group Ltd.