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

作　　者：Yang-Jin Baima Dan-Dan Shi Xing-Ya Shi Li Yang Yun-Tao Zhang Ba-Sang Xiao He-Yan Wang Hang-Yong He 

机构地区：[1]Department of Pulmonary Medicine,Lhasa People’s Hospital,Lhasa 850013,Tibet Autonomous Region,China [2]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 [3]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

出　　处：《World Journal of Clinical Cases》2022年第34期12717-12725,共9页世界临床病例杂志

基　　金：Supported by Science and Technology Program of Tibet Autonomous Region,No.XZ202201ZY0037G.

摘　　要：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 the

关 键 词：Pneumoperitonium Tension ISOLATED NON-SURGICAL BRONCHOSCOPY Case report 

分 类 号：R562[医药卫生—呼吸系统]