Pneumoperitoneum, Pneumoretroperitoneum, and Pneumoscrotum Following Transanal Excision of Rectal Polyp

A 69-year-old male was referred for evaluation of an endoscopically unresectable sessile polypoid lesion found on screening colonoscopy at an outside institution. The patient was observed in the postanesthesia care unit until he met standard discharge criteria and was subsequently discharged home the same day. Both of the other transanal cases described the excision as more proximal, at 4 and 6 cm proximal to the anal verge. 3 Given the location of our patient’s lesion in the distal anal canal, our resection did not violate or even approach the peritoneal reflection, making the radiographic finding of pneumoperitoneum even more surprising.