Tension pneumoperitoneum following upper endoscopy

Area of Science:

• Gastroenterology
• Surgical Complications
• Critical Care Medicine

Background:

• Perforation of the digestive tract is a rare but serious complication of endoscopic procedures.
• Abdominal compartment syndrome resulting from endoscopic perforation is exceptionally uncommon, with fewer than 20 reported cases.

Observation:

• A case of jejunal perforation occurred during an upper gastrointestinal endoscopy.
• The perforation led to tension physiology, mesenteric ischemia, severe acidosis, renal failure, coagulopathy, and massive gastrointestinal hemorrhage.

Findings:

• The patient experienced sudden shock upon abdominal decompression, suggesting possible reperfusion injury.
• Despite resuscitative efforts, the patient's condition deteriorated, leading to death.

Implications:

• This case underscores the critical risks associated with endoscopic perforations, particularly the development of abdominal compartment syndrome.
• It highlights the potential for rapid physiological deterioration and the challenges in managing such severe complications.
• Early recognition and management strategies for these rare but life-threatening events are crucial in gastrointestinal endoscopy.