Emergency percutaneous needle decompression for tension pneumoperitoneum
<p>Abstract</p> <p>Background</p> <p>Tension pneumoperitoneum as a complication of iatrogenic bowel perforation during endoscopy is a dramatic condition in which intraperitoneal air under pressure causes hemodynamic and ventilatory compromise. Like tension pneumothorax,...
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| Format: | Article |
| Language: | English |
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BMC
2011-05-01
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| Series: | BMC Gastroenterology |
| Online Access: | http://www.biomedcentral.com/1471-230X/11/48 |
| _version_ | 1818496773918818304 |
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| author | Körner Markus Stocker Urban Chiapponi Costanza Ladurner Roland |
| author_facet | Körner Markus Stocker Urban Chiapponi Costanza Ladurner Roland |
| author_sort | Körner Markus |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Tension pneumoperitoneum as a complication of iatrogenic bowel perforation during endoscopy is a dramatic condition in which intraperitoneal air under pressure causes hemodynamic and ventilatory compromise. Like tension pneumothorax, urgent intervention is required. Immediate surgical decompression though is not always possible due to the limitations of the preclinical management and sometimes to capacity constraints of medical staff and equipment in the clinic.</p> <p>Methods</p> <p>This is a retrospective analysis of cases of pneumoperitoneum and tension pneumoperitoneum due to iatrogenic bowel perforation. All patients admitted to our surgical department between January 2005 and October 2010 were included. Tension pneumoperitoneum was diagnosed in those patients presenting signs of hemodynamic and ventilatory compromise in addition to abdominal distension.</p> <p>Results</p> <p>Between January 2005 and October 2010 eleven patients with iatrogenic bowel perforation were admitted to our surgical department. The mean time between perforation and admission was 36 ± 14 hrs (range 30 min - 130 hrs), between ER admission and begin of the operation 3 hrs and 15 min ± 47 min (range 60 min - 9 hrs). Three out of eleven patients had clinical signs of tension pneumoperitoneum. In those patients emergency percutaneous needle decompression was performed with a 16G venous catheter. This improved significantly the patients' condition (stabilization of vital signs, reducing jugular vein congestion), bridging the time to the start of the operation.</p> <p>Conclusions</p> <p>Hemodynamical and respiratory compromise in addition to abdominal distension shortly after endoscopy are strongly suggestive of tension pneumoperitoneum due to iatrogenic bowel perforation. This is a rare but life threatening condition and it can be managed in a preclinical and clinical setting with emergency percutaneous needle decompression like tension pneumothorax. Emergency percutaneous decompression is no definitive treatment, only a method to bridge the time gap to definitive surgical repair.</p> |
| first_indexed | 2024-12-10T18:37:11Z |
| format | Article |
| id | doaj.art-2afbf0c376144a3db8b0863331cc292f |
| institution | Directory Open Access Journal |
| issn | 1471-230X |
| language | English |
| last_indexed | 2024-12-10T18:37:11Z |
| publishDate | 2011-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Gastroenterology |
| spelling | doaj.art-2afbf0c376144a3db8b0863331cc292f2022-12-22T01:37:45ZengBMCBMC Gastroenterology1471-230X2011-05-011114810.1186/1471-230X-11-48Emergency percutaneous needle decompression for tension pneumoperitoneumKörner MarkusStocker UrbanChiapponi CostanzaLadurner Roland<p>Abstract</p> <p>Background</p> <p>Tension pneumoperitoneum as a complication of iatrogenic bowel perforation during endoscopy is a dramatic condition in which intraperitoneal air under pressure causes hemodynamic and ventilatory compromise. Like tension pneumothorax, urgent intervention is required. Immediate surgical decompression though is not always possible due to the limitations of the preclinical management and sometimes to capacity constraints of medical staff and equipment in the clinic.</p> <p>Methods</p> <p>This is a retrospective analysis of cases of pneumoperitoneum and tension pneumoperitoneum due to iatrogenic bowel perforation. All patients admitted to our surgical department between January 2005 and October 2010 were included. Tension pneumoperitoneum was diagnosed in those patients presenting signs of hemodynamic and ventilatory compromise in addition to abdominal distension.</p> <p>Results</p> <p>Between January 2005 and October 2010 eleven patients with iatrogenic bowel perforation were admitted to our surgical department. The mean time between perforation and admission was 36 ± 14 hrs (range 30 min - 130 hrs), between ER admission and begin of the operation 3 hrs and 15 min ± 47 min (range 60 min - 9 hrs). Three out of eleven patients had clinical signs of tension pneumoperitoneum. In those patients emergency percutaneous needle decompression was performed with a 16G venous catheter. This improved significantly the patients' condition (stabilization of vital signs, reducing jugular vein congestion), bridging the time to the start of the operation.</p> <p>Conclusions</p> <p>Hemodynamical and respiratory compromise in addition to abdominal distension shortly after endoscopy are strongly suggestive of tension pneumoperitoneum due to iatrogenic bowel perforation. This is a rare but life threatening condition and it can be managed in a preclinical and clinical setting with emergency percutaneous needle decompression like tension pneumothorax. Emergency percutaneous decompression is no definitive treatment, only a method to bridge the time gap to definitive surgical repair.</p>http://www.biomedcentral.com/1471-230X/11/48 |
| spellingShingle | Körner Markus Stocker Urban Chiapponi Costanza Ladurner Roland Emergency percutaneous needle decompression for tension pneumoperitoneum BMC Gastroenterology |
| title | Emergency percutaneous needle decompression for tension pneumoperitoneum |
| title_full | Emergency percutaneous needle decompression for tension pneumoperitoneum |
| title_fullStr | Emergency percutaneous needle decompression for tension pneumoperitoneum |
| title_full_unstemmed | Emergency percutaneous needle decompression for tension pneumoperitoneum |
| title_short | Emergency percutaneous needle decompression for tension pneumoperitoneum |
| title_sort | emergency percutaneous needle decompression for tension pneumoperitoneum |
| url | http://www.biomedcentral.com/1471-230X/11/48 |
| work_keys_str_mv | AT kornermarkus emergencypercutaneousneedledecompressionfortensionpneumoperitoneum AT stockerurban emergencypercutaneousneedledecompressionfortensionpneumoperitoneum AT chiapponicostanza emergencypercutaneousneedledecompressionfortensionpneumoperitoneum AT ladurnerroland emergencypercutaneousneedledecompressionfortensionpneumoperitoneum |