Perforation of Bowel Following Endoscopy Leading to Tension Pneumoperitoneum

Dinesh N; Mithul V S; Rajani Sundar; Dinesh kumar Gunasekaran

Volume : X, Issue : VI, June - 2020

Perforation of Bowel Following Endoscopy Leading to Tension Pneumoperitoneum

Dinesh N, Mithul V S, Rajani Sundar, Dinesh Kumar Gunasekaran

Abstract :

This was a case of tension pneumoperitoneum, very rare and potentially lethal complication, following colonoscopy under general anesthesia in 14 months old child with Inflammatory bowel disease. An acute, tense abdomen was noticed during colonoscopy, with progressive difficulty in ventilation and hemodynamic instability. The procedure was discontinued immediately. All attempts to improve ventilation failed. Hemodynamic supports were started. Decompression of the insufflated air did not improve the condition. Perforation was suspected. Urgent imaging of the abdomen showed pneumoperitoneum. Immediate percutaneous needle decompression of the abdomen was done after which ventilation and hemodynamics dramatically improved. After stabilization, surgical exploration was done. Summary: Tension pneumoperitoneum during pediatric endoscopic procedures is a rare complication posing significant challenges to an anesthesiologist in recognition and management. It should be suspected in a tense abdomen with cardiopulmonary compromise following an endoscopic procedure. Percutaneous needle decompression is life–saving and need not be delayed until surgical exploration. Radiological confirmation should not delay intervention in strong clinical suspicion