Pneumoperitoneum Post Esophageal Stent Insertion Managed With Paracentesis

Gastrointestinal tract perforation is a known complication of endoscopy and may present itself as a pneumoperitoneum, pneumomediastinum or less commonly subcutaneous emphysema. Due to high insufflation pressures, barotrauma or mechanical trauma may result in a large pneumoperitoneum; however, the leak may spontaneously seal once insufflation has ceased. While unwell and peritonitic patients require prompt surgical intervention, in many cases patients may be clinically stable and respond appropriately to conservative management. We present the case of pneumoperitoneum post esophageal stent insertion for management of malignant dysphagia in a 74-year-old female patient. She experienced severe epigastric pain immediately post procedure and on image confirmation of a pneumoperitoneum underwent a paracentesis with significant pain relief and was then successfully managed conservatively. This case highlights that paracentesis may provide significant symptomatic relief from decompression of intra-abdominal free gas and facilitate non-operative management of pneumoperitoneum post upper gastrointestinal tract endoscopy.