Pneumomediastinum and Tension Pneumoperitoneum following Bronchioloalveolar lavage in a mechanically ventilated patient

Po, Pien-Lung; Bai, Hsueh-Fen; Lin, Chia-Ching; Lin, Ching‐Long

doi:10.1016/j.rmcr.2021.101341

Cited by 4 publications

(5 citation statements)

References 24 publications

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“…The abdominal compartment syndrome has been defined as high intraabdominal pressure that causes end-organ compromise [ 14 ]. A fatality has been reported in a frail patient with massive retroperitoneal air post-intubation and flexible bronchoscopy, which led to the collapse of the inferior vena cava and left-sided intra-abdominal organs shift where the next of kin declined surgical decompression [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Spontaneously Resolving Pneumoperitoneum and Pneumomediastinum: A Report of Two Cases

Mahmood,

Zafar,

Berliti

et al. 2024

Cureus

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We present here an interesting case report of two patients with spontaneous pneumomediastinum and iatrogenic pneumoperitoneum. The patients were assessed and queried following a chest X-ray abnormality and query based on the history of recent urological procedures on a background of awaiting gastrooesophageal surgery at a tertiary centre respectively. Although these patients were successfully managed with the best supportive approach and periodic imaging review, it remains important to be aware that fatalities have been reported in the literature. We hope this case report will help those involved in the care of the patient to be aware of these conditions as differentials when history points towards episodes of coughing or recent surgical input.

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Section: Discussionmentioning

confidence: 99%

Spontaneously Resolving Pneumoperitoneum and Pneumomediastinum: A Report of Two Cases

Mahmood,

Zafar,

Berliti

et al. 2024

Cureus

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“…Su causa más frecuente es la perforación gastrointestinal secundaria a procesos endoscópicos digestivos, sin embargo, una vez descartada la causa abdominal, el origen torácico es el más frecuente, relacionándose con procedimientos de manipulación de la vía aérea que van desde uso de cánulas nasales de alto flujo hasta la ventilación mecánica no invasiva. 2,4 La aparición de neumoperitoneo asociado o no a neumomediastino y/o neumotórax secundario a BF se ha encontrado asociada a hiperinsuflación con balón, cánulas nasales o a la realización de biopsias transbronquiales 1,[5][6][7] .…”

Section: Discussionunclassified

Neumoperitoneo como complicación de fibrobroncoscopia. Reporte de un caso

Liendo-Martínez,

Briones-Alvarado,

Gallo-González

et al. 2023

RPR

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El uso diagnóstico y terapéutico de la broncoscopia flexible (BF) ha tenido una gran evolución desde que Gustav Killian realizó en 1897 la primera endoscopia traqueal para extraer un cuerpo extraño 1 . Con el pasar de los años se ha demostrado que es un procedimiento seguro 2 con una mortalidad escasa (< 0.1%) siendo sus complicaciones infrecuentes y derivadas principalmente del tipo de técnica, de las propias comorbilidades del paciente y de la sedación 3 . Dentro de las complicaciones infrecuentes podemos mencionar el neumomediastino y el neumoperitoneo que generalmente se deben a la presencia de una ruptura gástrica. Presentamos el caso de un paciente de 58 años que 15 días tras la realización de una BF, presenta el hallazgo incidental de un neumoperitoneo asintomático sin evidencia de lesión gástrica.

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“…Tension pneumoperitonium was reported in the majority of the cases we reviewed, and in more than half of these cases there was acute circulatory or respiratory failure[ 3 , 4 , 6 , 8 ] or cardiopulmonary arrest[ 9 ], which may lead to a fatal outcome[ 18 ]. The initial step in treatment should be prompt resuscitation and life support.…”

Section: Discussionmentioning

confidence: 99%

“…Pneumoperitonium is a rare complication during bronchoscopy[ 1 , 2 ]. Tension pneumoperitonium may cause acute respiratory and hemodynamic failure[ 1 , 2 ], and can give rise to fatal consequences[ 3 , 4 ]. When pneumoperitonium is complicated with pneumothorax or pneumomediastinum, it is usually due to high positive pressure ventilation or airway/alveolar rupture[ 2 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

How to manage isolated tension non-surgical pneumoperitonium during bronchoscopy? A case report

Baima¹,

Shi²,

Shi³

et al. 2022

World J Clin Cases

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BACKGROUND Tension pneumoperitonium is a rare complication during bronchoscopy that can cause acute respiratory and hemodynamic failure, with fatal consequences. Isolated pneumoperitonium during bronchoscopy usually results from ruptures of the abdominal viscera that need surgical repair. Non-surgical pneumoperitoneum (NSP) refers to some pneumoperitoneum that could be relieved without surgery and only by conservative therapy. However, the clinical experience of managing tension pneumoperitonium during bronchoscopy is limited and controversial. CASE SUMMARY A 51-year-old female was admitted to our hospital for cough with bloody sputum of seven days. On the 8 th day of her admission, a bronchoscopy was arranged for bronchial-alveolar lavage to detect possible pathogens in the lower respiratory tract, as oxygen was delivered via a 12 F nasopharyngeal cannula, approximately 5-6 cm from the tip of the catheter, with a flow rate of 5-10 L/min. After four minutes of bronchoscopy, the patient suddenly vomited 20 mL of water, followed by severe abdominal pain, while physical examination revealed obvious abdominal distension, as well as hardness and tenderness of the whole abdomen, which was considered pneumoperitonium, and the bronchoscopy was terminated immediately. A computer tomography scan indicated isolated tension pneumoperitonium, and abdominal decompression was performed with a drainage tube, after which her symptoms were relieved. A multidisciplinary expert consultation discussed her situation and a laparotomy was suggested, but finally refused by her family. She had no signs of peritonitis and was finally discharged 5 d after bronchoscopy with a good recovery. CONCLUSION The possibility of tension pneumoperitonium during bronchoscopy should be guarded against, and given its serious clinical consequences, cardiopulmonary instability should be treated immediately. Varied strategies could be adopted according to whether it is complicated with pneumothorax or pneumomediastinum, and the presence of peritonitis. When considering NSP, conservative therapy maybe a reasonable option with good recovery. An algorithm for the management of pneumoperitonium during bronchoscopy is proposed, based on the features of the case series reviewed and our case reported.

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Pneumomediastinum and Tension Pneumoperitoneum following Bronchioloalveolar lavage in a mechanically ventilated patient

Cited by 4 publications

References 24 publications

Spontaneously Resolving Pneumoperitoneum and Pneumomediastinum: A Report of Two Cases

Spontaneously Resolving Pneumoperitoneum and Pneumomediastinum: A Report of Two Cases

Neumoperitoneo como complicación de fibrobroncoscopia. Reporte de un caso

How to manage isolated tension non-surgical pneumoperitonium during bronchoscopy? A case report

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