Tension pneumoperitoneum: Case report of a rare form of acute abdominal compartment syndrome

Highlights

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  Pneumoperitoneum is a rare cause of ACS.

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  A defined approach has not been established.

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  Whenever possible a minimally invasive approach should be attempted.

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  Avoiding laparotomy may benefit certain patients.

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  Reports are important in order to establish a treatment protocol.

Abstract

Introduction: Tension pneumoperitoneum is a severe and rare form of pneumoperitoneum with concomitant hemodynamic instability and respiratory failure. It is a variant of abdominal compartment syndrome (ACS) causing an abrupt increase in intra-abdominal pressure.

Presentation of case: We present a case of pneumoperitoneum, after an endoscopic mucosal resection with the development of ACS. The patient was successfully treated with percutaneous decompression.

Discussion: Decompressive laparotomy is the first treatment option for both most forms of pneumoperitoneum and ACS; nevertheless, this issue is controversial. Recent reports have shown that some patients may be candidates for a minimally invasive catheter decompression avoiding major decompressive surgery. Identifying these patients is vital to avoiding unnecessary surgeries.

Conclusions: Tension pneumoperitoneum is a life-threatening event, early detection and intervention is critical in order to provide prompt and optimal treatment approaches.