Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2022; 10(34): 12717-12725
Published online Dec 6, 2022. doi: 10.12998/wjcc.v10.i34.12717
How to manage isolated tension non-surgical pneumoperitonium during bronchoscopy? A case report
Yang-Jin Baima, Dan-Dan Shi, Xing-Ya Shi, Li Yang, Yun-Tao Zhang, Ba-Sang Xiao, He-Yan Wang, Hang-Yong He
Yang-Jin Baima, Dan-Dan Shi, Xing-Ya Shi, Li Yang, Yun-Tao Zhang, Ba-Sang Xiao, Department of Pulmonary Medicine, Lhasa People’s Hospital, Lhasa 850013, Tibet Autonomous Region, China
He-Yan Wang, Department of Critical Care Medicine, The Sixth Hospital of Guiyang, School of Basic Medicine, Guizhou University of Traditional Chinese Medicine, Guiyang 550002, Guizhou Province, China
Hang-Yong He, Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
Author contributions: All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data, reviewed and approved the final manuscript, contributed significantly to this study; Wang HY and He HY take full responsibility for the integrity of the submission and publication, and are involved in the study design; Shi DD, Baima YJ, Wang HY and He HY had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis, and were responsible for data verification, analysis, and drafting of the manuscript; Zhang YT, Yang L and Xiao BS had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis; Shi DD and Baima YJ were responsible for the data collection; Baima YJ and Shi DD made equal contributions.
Supported by Science and Technology Program of Tibet Autonomous Region, No. XZ202201ZY0037G.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hang-Yong He, MD, Chief Physician, Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing 100020, China. yonghang2004@sina.com
Received: August 31, 2022
Peer-review started: August 29, 2022
First decision: September 26, 2022
Revised: October 5, 2022
Accepted: October 31, 2022
Article in press: October 31, 2022
Published online: December 6, 2022
Processing time: 93 Days and 4.2 Hours
Abstract
BACKGROUND

Tension pneumoperitonium is a rare complication during bronchoscopy that can cause acute respiratory and hemodynamic failure, with fatal consequences. Isolated pneumoperitonium during bronchoscopy usually results from ruptures of the abdominal viscera that need surgical repair. Non-surgical pneumoperitoneum (NSP) refers to some pneumoperitoneum that could be relieved without surgery and only by conservative therapy. However, the clinical experience of managing tension pneumoperitonium during bronchoscopy is limited and controversial.

CASE SUMMARY

A 51-year-old female was admitted to our hospital for cough with bloody sputum of seven days. On the 8th day of her admission, a bronchoscopy was arranged for bronchial-alveolar lavage to detect possible pathogens in the lower respiratory tract, as oxygen was delivered via a 12 F nasopharyngeal cannula, approximately 5-6 cm from the tip of the catheter, with a flow rate of 5-10 L/min. After four minutes of bronchoscopy, the patient suddenly vomited 20 mL of water, followed by severe abdominal pain, while physical examination revealed obvious abdominal distension, as well as hardness and tenderness of the whole abdomen, which was considered pneumoperitonium, and the bronchoscopy was terminated immediately. A computer tomography scan indicated isolated tension pneumoperitonium, and abdominal decompression was performed with a drainage tube, after which her symptoms were relieved. A multidisciplinary expert consultation discussed her situation and a laparotomy was suggested, but finally refused by her family. She had no signs of peritonitis and was finally discharged 5 d after bronchoscopy with a good recovery.

CONCLUSION

The possibility of tension pneumoperitonium during bronchoscopy should be guarded against, and given its serious clinical consequences, cardiopulmonary instability should be treated immediately. Varied strategies could be adopted according to whether it is complicated with pneumothorax or pneumomediastinum, and the presence of peritonitis. When considering NSP, conservative therapy maybe a reasonable option with good recovery. An algorithm for the management of pneumoperitonium during bronchoscopy is proposed, based on the features of the case series reviewed and our case reported.

Keywords: Pneumoperitonium; Tension; Isolated; Non-surgical; Bronchoscopy; Case report

Core Tip: Tension pneumoperitonium is a rare complication during bronchoscopy that can cause serious consequences. Isolated pneumoperitonium during bronchoscopy usually results from ruptures of the abdominal viscera that need surgical repair. Nonsurgical pneumoperitoneum (NSP) refers to some pneumoperitonium that could be relieved without surgery and only by conservative therapy. However, the clinical experience of managing tension pneumoperitonium during bronchoscopy is limited and controversial. Herein, we describe a rare case of isolated tension pneumoperitonium during bronchoscopy, which was recovered with no signs of peritonitis by conservative therapy. An algorithm for the management of pneumoperitonium during bronchoscopy is proposed.