Abstract
INTRODUCTION: Pneumo-mediastinum and subcutaneous emphysema are rare presentations of lower gastrointestinal tract perforation. PRESENTATION OF CASE: We are presenting the case of a middle aged man diagnosed with UC who presented with dyspnea and subcutaneous emphysema, attributed to multiple perforations including the stomach and colon. CASE DISCUSSION: Patients with ulcerative colitis (UC) are at an increased risk of perforations due to friability of colonic mucosa given the chronic inflammation and relapsing flares. Chronic use of steroids further predisposes to stress ulcers. These pathologies sometimes coexist and identification of each is crucial for the appropriate treatment plan. CONCLUSION: The case allows for a learning opportunity focusing on coexisting pathologies which may be differentiated based on anatomical knowledge and patient presentation.