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

• Published in: International journal of surgery case reports 2024-09, Vol.122, p.110087, Article 110087
• Main Authors: Mulkey, Eric, Hebert, Brielle, Stratton, Michael, Werner, Andrew
• Format: Article
• Language: English
• Subjects: Acute colonic Pseudo-obstruction; Needle decompression; Ogilvie's syndrome; Tension pneumoperitoneum
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2024.110087

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. 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. 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. Select patients and clinical presentations of tension pneumoperitoneum can be managed successfully with bedside needle decompression if diagnosis and intervention is prompt. •Tension pneumoperitoneum is a rare, life-threatening condition that can lead to cardiovascular and/or respiratory collapse.•The vast majority of GI perforations that lead to tension physiology require surgical intervention.•Early diagnosis of tension pneumoperitoneum and prompt decompression can be an effective palliative measure to manage tension pneumoperitoneum and avoid major abdominal surgery.