We report two cases with similar main complaints: dysphonia and subcutaneous cervical emphysema. After diagnosis procedures we identified pneumomediastinum, pneumoperitoneum and pneumoretroperitoneum caused by colonic perforation. Both patients underwent surgical treatment at Hospital Campo Arañuelo, Navalmoral de la Mata. Dysphonia and subcutaneous cervical emphysema are infrequent symptoms of presentation for occult gastrointestinal tract perforation or any retroperitoneal condition. Subcutaneous emphysema due to colonic perforation is extremely uncommon but it must to be considerate as a cause when its etiology remains unknown. Non iatrogenic subcutaneous emphysema is very rare in publications and is mostly associated with perforated sigmoid diverticulitis or carcinoma and the prognosis is poor Both patients underwent surgical treatment and also a wide spectrum antibiotic course. One of them needed respiratory support in the intensive care unit, and, in the outcome, he required a second surgical procedure to evacuate a residual abscess before discharge.