DR.MOHAMMED IRFAN SHEIKHover 5 years ago

Tension Pneumoperitoneum

A 65-year-old woman who had undergone colonoscopy with removal of multiple polyps had become unresponsive at the end of the procedure and was transferred to the emergency department for evaluation. She regained consciousness but remained in distress with diaphoresis. On physical examination, the heart rate was 130 beats per minute, and the skin of the abdominal and pelvic areas and lower limbs was mottled. The abdomen was massively distended, tympanitic, and diffusely tender to palpation with evidence of guarding. Chest and abdominal radiographs (Panels A and B) revealed a large amount of free air under the diaphragm with centralization of the intraabdominal contents that was consistent with a massive tension pneumoperitoneum. The patient was taken to the operating room, where she underwent a decompressive laparotomy (Video) and a wedge partial colectomy to correct an iatrogenic perforation of the ascending colon. The patient had an uneventful recovery and was discharged home on the third postoperative day.