[Tension pneumothorax during removal of a foreign body from the esophagus]

Extracting foreign bodies from the esophagus is a common procedure in emergency rooms. We report the case of an 82-year-old man who came to the emergency room after swallowing a clam shell. After three successive examinations by fiberoptic endoscopy, the last of which was performed with general anesthesia, the patient suffered pneumomediastinum and pneumothorax first on the right side and then, within a few hours, on the left. After extraction of the foreign body, bilateral pleural drainage and emergency repair of esophageal perforation were required. Episodes of pneumothorax have been described after endoscopic procedures on the digestive tract such as esophagoscopy. The cause of esophageal perforation described may be iatrogenic, produced during esophageal manipulations or it may be caused by the foreign body itself, by an awake patient's performance of Valsalva maneuvers during esophagoscopy, or the entrance of air in the pleural cavity through esophageal perforation; any of these would explain the presentation of pneumothorax in this case. In the presence of sudden cardiorespiratory deterioration in a patient undergoing an endoscopic procedure, a diagnosis of tension pneumothorax must be considered.