Gastric rupture during fiberoptic bronchoscopy, a rare complication of oxygen administration by nasopharyngeal cannula: a case report

Pereira, Inês Sucena; Ferreira, Luísa Conceição Martins; Tinoco, Eduarda Milheiro; Shiang, Teresa; Oliveira, Ana; Pereira, Ana Isabel

doi:10.1016/j.bjane.2021.12.009

Cited by 1 publication

(2 citation statements)

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“…The mechanism of pneumoperitonium during bronchoscopy is manifested by high-pressure air in the ruptured airway, alveoli, or hollow viscus[ 5 , 8 , 9 ]. In some cases, such as rigid bronchoscopy[ 5 , 8 ], TBLB[ 1 ], TBNA[ 2 , 6 ], or foreign body removal[ 5 ], pneumoperitonium occurs as an intro-airway procedural complication.…”

Section: Discussionmentioning

confidence: 99%

“…Tension pneumoperitonium was reported in the majority of the cases we reviewed, and in more than half of these cases there was acute circulatory or respiratory failure[ 3 , 4 , 6 , 8 ] or cardiopulmonary arrest[ 9 ], which may lead to a fatal outcome[ 18 ]. The initial step in treatment should be prompt resuscitation and life support.…”

Section: Discussionmentioning

confidence: 99%

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

Baima¹,

Shi²,

Shi³

et al. 2022

World J Clin Cases

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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 8 th 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 therapy maybe a reasonable option with good recovery. An algorithm for the management of pneumoperitonium during bronchoscopy is proposed, based on the features of the case series reviewed and our case reported.

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