"flatus profuse present in the muscles": Subcutaneous emphysema of the lower abdominal wall and thighs, described in 1593 by fabricius hildanus

Background: Between 1598 and 1641, 600 medical and surgical observations made by the famous German surgeon Guilhelmius Fabricius Hildanus (1560-1634) were published in his Observationum et curationum chirurgicarum centuriae I-VI. Methods: Review of the extant document for evidence of infection-related cases. Results: One of the case reports, published as Observatio LXX in the fifth Centuria, bears the title (in translation) Of flatus, profuse present in the muscles. This case report probably is the earliest accurate description of subcutaneous emphysema of the lower abdomen and thighs secondary to a retroperitoneal abscess. Conclusion: The presence of gas in the superficial tissues of the abdominal wall or thighs is a rare feature and can be a late sign of an otherwise-obscure intra-abdominal abscess with gas-producing bacteria. Fabricius Hildanus almost certainly was the first to document this rare feature in 1593, and judged it important enough to describe in his Centuriae.

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