Tension Pneumoperitoneum: A Rare Complication of Upper Gastrointestinal Endoscopy

Symeonidis, Nikolaos; Ballas, Konstantinos; Pavlidis, Efstathios T; Psarras, Kyriakos; Pavlidis, Theodosios; Sakantamis, Athanasios K.

doi:10.4293/108680812x13462882736655

Cited by 13 publications

(7 citation statements)

References 11 publications

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“…Most reported causes of TP are complications of upper or lower gastrointestinal endoscopy [ 6 , 7 ] and cardiopulmonary resuscitation [ 8 , 9 ]. Air insufflation by endoscopy causes a large amount of gas leakage into the peritoneal cavity through the perforated wall of the gastrointestinal tract owing to an iatrogenic procedure or ulcer.…”

Section: Discussionmentioning

confidence: 99%

Tension pneumoperitoneum caused by intestinal perforation from underlying colon cancer: a case report

et al. 2020

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Background Tension pneumoperitoneum, a form of abdominal compartment syndrome, is an important clinical condition. Increased pressure in the intraperitoneal cavity leads to respiratory and circulatory instability. Most of the reported cases include complications due to active air infusion into the peritoneal cavity or trauma; however, few reports are available on tension pneumoperitoneum caused by perforation from colon cancer. We present a case of a patient with tension pneumoperitoneum caused by gastrointestinal perforation owing to colon cancer. Case presentation A 63-year-old Japanese man with altered mental state was brought to our emergency department. He was in shock, and an abdominal radiograph suggested gastrointestinal perforation. Despite rapid fluid infusion and inotropic support, his condition deteriorated. His abdomen was tensely distended; abdominal computed tomography showed significant intra-abdominal gas. Following immediate needle decompression, his circulatory status improved. Emergent laparotomy revealed an approximately 10-cm tumor (adenocarcinoma) in the colon, which caused the perforation. Conclusions A perforated wall or the surrounding omental fat that acts as a one-way valve could lead to tension pneumoperitoneum without active air infusion. Although tension pneumoperitoneum is a life-threatening condition, it is reversible if prompt diagnosis and immediate decompression are performed. Physicians should always consider this condition as one of the causes of shock or cardiopulmonary arrest, even without an apparent medical history of active air infusion or trauma.

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Section: Discussionmentioning

confidence: 99%

Tension pneumoperitoneum caused by intestinal perforation from underlying colon cancer: a case report

et al. 2020

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“…Similar to tension pneumothorax, emergency percutaneous needle decompression is needed [ 6 ]. When managing hollow organ perforation-related TP, a venous catheter may be percutaneously inserted to stabilize the patient’s vital signs and to bridge the time to the start of the emergency operation [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…TP may result in an elevation of the diaphragm, which reduces lung volume and compresses the inferior vena cava, which in turn reduces the venous return and cardiac output and can result in aortic occlusion [ 4 ]. Various etiologies have been reported, including gastrointestinal perforation, barotrauma in ventilated patients, and diaphragmatic hernia repair [ 5 ]. Here, we report the case of a morbidly obese woman with TP that developed after surgery for endometrial cancer and the mesh repair of a ventral hernia.…”

Section: Introductionmentioning

confidence: 99%

Tension pneumoperitoneum after surgery for endometrial cancer and hernia in a morbidly obese female: a case report

et al. 2018

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BackgroundObesity is a risk factor for the development of endometrial cancer and abdominal wall hernias. We report a case of tension pneumoperitoneum that developed after gynecological surgery and mesh repair of a ventral hernia.Case presentationA 57-year-old Asian Taiwanese woman with a body mass index of 52.9 (kg/m2) underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy due to endometrial cancer, and ventral herniorrhaphy with mesh due to ventral hernia. Tension pneumoperitoneum with severe dyspnea developed on postoperative day 14. Rather than performing emergency laparotomy as in visceral perforation, a transabdominal catheter was inserted to drain the intra-abdominal gas. This approach dramatically relieved the tension pneumoperitoneum and dyspnea. Our patient then recovered smoothly; the catheter was removed on postoperative 24, and she was discharged on postoperative day 28. The clinical course of the endometrial cancer and repaired ventral hernia was well at the 1-year follow-up.ConclusionsTension pneumoperitoneum, which may result from the valve effect of unhealed abdominal mesh, could develop after gynecological surgery and hernia mesh repair in obese patients. Under these conditions, emergency drainage of the intra-abdominal gas by catheter insertion is sufficient to relieve the abdominal pressure and correct the conditions, while emergency laparotomy as in visceral perforation is unnecessary and may increase patient morbidities.

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“…The management of pneumoperitoneum after endoscopic perforation can be non-operative or operative depending on the size of the perforation, clinical symptoms and hemodynamic stability. Tension pneumoperitoneum (TPP) has been defined as life threatening severe intra-abdominal hypertension due to massive accumulation of intraperitoneal air [ 2 ]. TPP can result in a constellation of clinical symptoms including abdominal distension, dyspnea and signs of venous congestion [ 2–4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Tension pneumoperitoneum (TPP) has been defined as life threatening severe intra-abdominal hypertension due to massive accumulation of intraperitoneal air [ 2 ]. TPP can result in a constellation of clinical symptoms including abdominal distension, dyspnea and signs of venous congestion [ 2–4 ]. As TPP progresses, it can lead to hemodynamic instability and abdominal compartment syndrome (ACS), demanding urgent intervention.…”

Section: Introductionmentioning

confidence: 99%

Tension pneumoperitoneum following upper endoscopy

Denkler

Sterbling

Seoudi

2020

Journal of Surgical Case Reports

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Perforation of the digestive tract is a rare complication of endoscopy. Massive accumulation of air within the peritoneum resulting in the abdominal compartment syndrome is much less common with <20 cases reported. In this report we present a case of jejunal perforation during an upper gastrointestinal endoscopy that resulted in tension physiology with mesenteric ischemia, severe acidosis, renal failure, coagulopathy and massive gastrointestinal hemorrhage. The patient had a sudden onset of shock as soon as her abdomen was decompressed, indicating that she possibly developed a reperfusion injury. She did not respond to resuscitative efforts and ultimately died.

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Tension Pneumoperitoneum: A Rare Complication of Upper Gastrointestinal Endoscopy

Abstract: The combination of acute abdominal distension with hemodynamic instability following an endoscopic procedure should raise the suspicion of tension pneumothorax. Immediate needle decompression may be life saving.

Cited by 13 publications

References 11 publications

Tension pneumoperitoneum caused by intestinal perforation from underlying colon cancer: a case report

Tension pneumoperitoneum caused by intestinal perforation from underlying colon cancer: a case report

Tension pneumoperitoneum after surgery for endometrial cancer and hernia in a morbidly obese female: a case report

Tension pneumoperitoneum following upper endoscopy

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