How to manage isolated tension non-surgical pneumoperitonium during bronchoscopy? A case report

Table 1 Case series reported pneumoperitoneum associated with bronchoscopy

Ref.	Age	Sex	BSP type	Biopsy procedure	O2 supply	Symptoms during BSP	PT or PM	Isolated PP	Tension PP	Respiratory or hemodynamic failure	Intubaion and MV	Viscus rupture	Laparotomy or Conservative treatment	Outcome
Nikolaev et al[1], 2003	82	F	Fiberoptic	TBLB	NPC	Sudden stuporotic bradycardic	PT + PM	No	Yes	No	Intubation air-bag	No	Laparoscopy	Discharged 3 d later
Abraham et al[2], 2011	76	F	Fiberoptic	TBNA	NPC	Abdominal pain	PM	No	Yes	No	No	No	Conservative observation in ICU	Discharged 2 d later
Dastidar[5], 2013	14 mo	M	Rigid	Foreign body removal	MV	Distended abdomen	PT + PM	No	No	No	Aborted	No	Conservative observation in ICU	Discharged 1 d later
Bednarz et al[8], 2015	42	F	Rigid	No	Bag mask	Respiratory arrest distended abdomen	No	Yes	Yes	RF and shock	Intubation	Gastric rupture	Emergent laparotomy	Recovered
El-kersh and Karnib[3], 2017	61	F	Fiberoptic	No	NPC	Abdominal pain tachycardia tachypnea	No	Yes	Yes	RF	Intubation	Gastric rupture	Emergent laparotomy	Recovered
Muriana et al[6], 2018	80	M	Fiberoptic	EBUS TBNA	NPC	Distended abdomen severe bradycardia arterial hypotension	No	Yes	Yes	RF and shock	Intubation	No	Needle decompression	Discharged 13 d later
Po et al[4], 2021	80	M	Fiberoptic	BALF	MV	Distended abdomen persistent hypotension	PM	No	Yes	Shock	Intubation	NA	Refused laparotomy by family	Died
Pereira et al[9], 2021	61	F	Fiberoptic	No	NPC	Sudden abdominal distension; cardiorespiratory arrest	PT + PM	No	Yes	RF and shock	Bag-mask ventilation & intubation	Gastric laceration	Needle decompression exploratory laparotomy	Discharged 4 d later
This case	51	F	Fiberoptic	No	NPC	Abdominal pain	No	Yes	Yes	No	No	No	Needle decompression	Discharged 5 d later
In summary	42-82 yr	F 6 M 3	Fiberoptic 7 Rigid 2	TBLB 1 TBNA 2 Foreign body 1	NPC 6 MV 2 bag mask 1	Abdominal pain 3 Distended abdomen 5 hypotension 2 cardiorespiratory arrest 1	PT + PM 3 PM 2 No 4	No 5 Yes 4	Yes 9 No 1	RF + shock 3 RF 1 Shock 1 No 4	Intubation 6 No 2	Gastric rupture 3 No 6	Conservative observation 2 Laparotomy 4 Needle decompression3	Discharged 8 Died 1

BSP: Bronchoscopy; IV: Intravenous; TBLB: Transbronchial lung biopsy; PT: Pneumothorax; PM: Pneumomediastinum; PP: Pneumoperitonium; MV: Mechanical ventilation; EBUS: Endobronchial ultrasound guidance; TBNA: Tranbronchila needle aspiration; NA: Not available; NPC: Nasopharyngeal cannula; RF: Respiratory failure.