title: Tension pneumothorax complicating endoscopic retrograde cholangiopancreatography: case report and systematic literature review.
abstract: Perforation of the duodenum, which is usually retroperitoneal, is a known complication of endoscopic retrograde cholangiopancreatography (ERCP). Association of the duodenal perforation with pneumothorax is rare and the development of tension pneumothorax is even rarer. We report a case of tension pneumothorax following an ERCP, which we successfully treated with chest tube insertion and laparotomy, and systematically review the other 10 cases reported in the literature. Four of these 10 cases had tension pneumothorax. All were to the right side of the chest. Patients were mainly female (7/10). The median (range) age was 70.5 (55-89) years. Four patients required surgery (40%) and one patient, who was not operated on, died (10%). Clinicians should be aware of this serious complication. Unexplained chest pain, dyspnoea, and oxygen desaturation with abdominal distension during ERCP must raise this possibility. Early clinical recognition and prompt management is essential to improve the outcome.
authors.affiliation: Department of Surgery, Al-Ain Hospital, United Arab Emirates.
authors.forename: Yousef I
authors.initials: YI
authors.lastname: Al-Ashaal
authors.forename: Ashraf F
authors.initials: AF
authors.lastname: Hefny
authors.forename: Farouk
authors.initials: F
authors.lastname: Safi
authors.forename: Fikri M
authors.initials: FM
authors.lastname: Abu-Zidan
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015505:Chest Tubes; D002758:Cholangiography; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D002763:Cholecystectomy; D002764:Cholecystitis / Q000175:diagnosis / Q000601:surgery*; D001651:Cholestasis, Extrahepatic / Q000175:diagnosis / Q000601:surgery*; D004322:Drainage / Q000379:methods; D004378:Duodenal Diseases / Q000175:diagnosis; D042241:Early Diagnosis; D005260:Female; D042882:Gallstones / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease; D007416:Intestinal Perforation / Q000175:diagnosis / Q000601:surgery; D007431:Intraoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012086:Reoperation; D012188:Retropneumoperitoneum / Q000175:diagnosis / Q000601:surgery; D014057:Tomography, X-Ray Computed