A case report of successful bedside needle decompression in the management of tension pneumoperitoneum secondary to colonic perforated colonic Pseudo-obstruction.

INTRODUCTION AND IMPORTANCE

Pneumoperitoneum is a well-known consequence of gastrointestinal perforations but can also be a consequence of medical diseases such as asthma exacerbations or interventions such as mechanical ventilation. Tension pneumoperitoneum is a rare, life-threatening form of large volume pneumoperitoneum that can cause cardiovascular and respiratory compromise due to increased intra-abdominal pressure.

CASE PRESENTATION

We present a case report where an 86-year-old male was diagnosed with large volume pneumoperitoneum with compression of the inferior vena cava and intra-abdominal hollow and solid organs due to a suspected splenic flexure perforation in the setting of an acute colonic pseudo-obstruction that was able to be successfully managed solely with bedside needle decompression.

CLINICAL DISCUSSION

Large volume pneumoperitoneum and tension physiology requires early diagnosis and prompt intervention. Patients are often critically ill and require major abdominal surgery if secondary to gastrointestinal perforation.

CONCLUSION

Select patients and clinical presentations of tension pneumoperitoneum can be managed successfully with bedside needle decompression if diagnosis and intervention is prompt.