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Delayed Tension Symptomatic Pneumoperitoneum After POEM Requiring Needle Decompression
Brian McGrath1, Lucie F Calderon, Mengdan Xie
1Division of Digestive Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.
Delayed tension pneumoperitoneum, a rare complication after per-oral endoscopic myotomy (POEM) for achalasia, requires ongoing vigilance. Computed tomography-guided aspiration is an effective treatment.
Area of Science:
- Gastroenterology
- Endoscopic Surgery
- Abdominal Surgery
Background:
- Per-oral endoscopic myotomy (POEM) is a primary treatment for achalasia.
- Tension pneumoperitoneum is a known, but typically periprocedural, complication of POEM.
- This complication can lead to significant hemodynamic instability.
Observation:
- This report details two cases of delayed tension pneumoperitoneum occurring several hours after an otherwise uncomplicated POEM procedure.
- The patients presented with symptoms of tension pneumoperitoneum well after the immediate post-operative period.
Findings:
- Delayed tension pneumoperitoneum can occur following POEM, necessitating extended patient monitoring.
- Computed tomography (CT)-guided aspiration proved effective in managing this delayed complication in both reported cases.
Implications:
- Clinicians should maintain vigilance for delayed tension pneumoperitoneum beyond the immediate periprocedural timeframe after POEM.
- Educating patients about the signs and symptoms of this rare complication is crucial for timely intervention.
- CT-guided aspiration offers a viable treatment option for delayed tension pneumoperitoneum post-POEM.
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