title: Tension pneumoperitoneum: a rare complication of upper gastrointestinal endoscopy.
abstract: BACKGROUND
  Tension pneumoperitoneum is defined as the massive accumulation of air in the peritoneal cavity, which results in a sudden increase in intraabdominal pressure. Various iatrogenic procedures are responsible for this complication. We herein report a case of tension  pneumoperitoneum resulting from upper gastrointestinal endoscopy.
  
  
  METHODS
  A 45-y-old man was referred to our department because of melena. Esophagogastroscopy was unsuccessful because of failure to inflate the stomach, and sudden abdominal distension was noted immediately  after the procedure. The hemodynamic status of the patient was compromised, and the imminent collapse was prevented with emergent needle paracentesis. Decompression of the abdominal cavity restored vital signs to normal allowing definitive surgical treatment.
  
  
  CONCLUSIONS
  Upper gastrointestinal  endoscopy is a rare cause of this life-threatening complication. The combination of acute abdominal distension with hemodynamic instability following endoscopic procedures should raise suspicion of tension pneumoperitoneum. Needle decompression is life-saving and should be performed instantly  upon recognition of this condition.
authors: Second Propedeutical Department of Surgery, Aristotle University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece. niksym@hotmail.com
authors: Nikolaos
authors: N
authors: Symeonidis
authors: Konstantinos
authors: K
authors: Ballas
authors: Efstathios
authors: E
authors: Pavlidis
authors: Kyriakos
authors: K
authors: Psarras
authors: Theodoros
authors: T
authors: Pavlidis
authors: Athanasios
authors: A
authors: Sakantamis
mesh_terms: D019299:Decompression, Surgical / Q000379:methods*; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008551:Melena / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008875:Middle Aged; D010529:Peritoneal Cavity / Q000601:surgery*; D011027:Pneumoperitoneum / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed