During colonoscopy, subcutaneous emphysema may occur as a result of colonic perforation into retroperitoneal area. In this report, a 54-year-old woman with sigmoid colon perforation following colonoscopy is described. Subcutaneous emphysema was the first manifestation of the perforation in this case. Initially, the patient received supportive, non-surgical treatment, but due to development of acute abdominal signs and symptoms in later stages, the patient underwent surgical treatment.

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