Tension pneumoperitoneum following upper gastrointestinal endoscopy.
Tension pneumoperitoneum is a potentially lethal complication of numerous iatrogenic procedures, including upper gastrointestinal (UGI) endoscopy. We report a 69-year-old man with UGI bleeding who developed tension pneumoperitoneum and cardiac arrest after UGI endoscopy. He was successfully resuscitated with needle decompression. Emergency surgery revealed a perforated gastric ulcer, and subtotal gastrectomy with Billroth II anastomosis was performed. Recovery was smooth and he was discharged from the hospital 18 days later. Tension pneumoperitoneum should be suspected in all patients who develop circulatory collapse with acutely distended abdomen after UGI endoscopy. Early identification relies on a high index of suspicion. Prompt treatment with needle decompression should not be delayed for confirmatory radiography once the clinical diagnosis is made.
Lu
Tsung-Chien
TC
Department of Emergency Medicine, National Taiwan University Hospital, Taipei.
Chen
Shey-Ying
SY
Wang
Hsiu-Po
HP
Lee
Chien-Chang
CC
Chen
Shyr-Chyr
SC
D000368:Aged; D019299:Decompression, Surgical / Q000295:instrumentation; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D008297:Male; D009339:Needles; D011027:Pneumoperitoneum / Q000209:etiology* / Q000628:therapy