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. 2019:55:112-116.
doi: 10.1016/j.ijscr.2019.01.014. Epub 2019 Jan 29.

Tension pneumoperitoneum: Case report of a rare form of acute abdominal compartment syndrome

Manuel Cadena  1 , Jaime Solano  1 , Nicolas Caycedo  1 , Daniel Gomez  2 , Eric E Vinck  3 , Pedro Quiroga  4 , Paula Gaete  4
Affiliations

Tension pneumoperitoneum: Case report of a rare form of acute abdominal compartment syndrome

Manuel Cadena et al. Int J Surg Case Rep. 2019.

Abstract

Introduction: Tension pneumoperitoneum is a severe and rare form of pneumoperitoneum with concomitant hemodynamic instability and respiratory failure. It is a variant of abdominal compartment syndrome (ACS) causing an abrupt increase in intra-abdominal pressure.

Presentation of case: We present a case of pneumoperitoneum, after an endoscopic mucosal resection with the development of ACS. The patient was successfully treated with percutaneous decompression.

Discussion: Decompressive laparotomy is the first treatment option for both most forms of pneumoperitoneum and ACS; nevertheless, this issue is controversial. Recent reports have shown that some patients may be candidates for a minimally invasive catheter decompression avoiding major decompressive surgery. Identifying these patients is vital to avoiding unnecessary surgeries.

Conclusions: Tension pneumoperitoneum is a life-threatening event, early detection and intervention is critical in order to provide prompt and optimal treatment approaches.

Keywords: Abdominal compartment syndrome; Laparotomy; Pneumoperitoneum; Surgical decompression; Tension pneumoperitoneum.

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Figures

Fig. 1
Fig. 1
Endoscopic ultrasound showing a 32 mm adenocarcinoma (dots). The ulcerated tumor does not invade the muscularis.
Fig. 2
Fig. 2
Distended abdomen at the end of the endoscopic procedure.
Fig. 3
Fig. 3
Abdominal radiography showing sub-diaphragmatic free air (white arrows), Rigler´s sign (white triangles), air in both sides of the intestine wall; and Falciform ligament sign (black arrow).
Fig. 4
Fig. 4
Abdominal CT-scan. a. Sagittal view showing the presence of air in the peritoneal cavity with posterior displacement of the intra-abdominal contents b. Axial view, showing the Falciform ligament sign (white arrow). c. Axial view showing percutaneous decompression with a multipurpose drainage catheter (white arrow) in the periumbilical position. d. Axial view after percutaneous decompression.
See this image and copyright information in PMC

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