Capnoperitoneum During Peroral Endoscopic Myotomy-Recognition and Management: A Case Report

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Anesthesiology

Background:

• Peroral endoscopic myotomy (POEM) is an effective treatment for esophageal achalasia.
• The procedure involves insufflating carbon dioxide into the gastrointestinal tract.
• This insufflation can lead to gas accumulation in surrounding cavities.

Observation:

• During POEM, significant capnoperitoneum (gas in the abdomen) developed in a patient.
• The gas accumulation adversely affected the patient's ventilation.
• The cause of the ventilation compromise was identified as intra-abdominal gas.

Findings:

• Needle decompression of the abdomen was performed to release the accumulated carbon dioxide.
• Following decompression, there was an immediate and significant improvement in the patient's ventilation.
• This highlights a direct link between capnoperitoneum and respiratory compromise during POEM.

Implications:

• Clinicians performing POEM must be vigilant for potential complications like capnoperitoneum.
• Recognizing and managing gas accumulation promptly is crucial for patient safety.
• Needle decompression is an effective intervention for ventilation issues arising from POEM-induced capnoperitoneum.