Tension pneumothorax as a complication of colonic perforation during colonoscopy: An anesthesiologist's nightmare

Colonoscopy is currently a widespread procedure used in screening for colorectal cancer. Iatrogenic colonic perforation during colonoscopy is a serious and potentially life-threatening complication that can cause significant morbidity and mortality. “Triple pneumo” (a combination of pneumothorax, pneumomediastinum, and pneumoperitoneum) following colonoscopy is a rare but a serious condition requiring immediate diagnosis and emergent intervention. In majority of these cases a colonic perforation is the initial injury that is followed by pneumothorax and pneumomediastinum through the potential anatomical connection with retroperitoneal and mediastinal spaces. In this rare case report we are presenting a case of “triple pneumo” with no evidence of colonic perforation. This patient developed a simultaneous pneumoperitoneum, pneumomediastinum, and a tension pneumothorax requiring immediate tube thoracostomy. This case may raise the awareness on the likelihood of these serious complications after colonoscopy.

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Colonic Perforation after Preoperative Endoscopic Tattooing with India Ink

Swiss Surgery ◽

10.1024/1023-9332.9.6.307 ◽

2003 ◽

Vol 9 (6) ◽

pp. 307-310 ◽

Cited By ~ 14

Author(s):

Gianom ◽

Hollinger ◽

Wirth

Keyword(s):

Colonic Perforation ◽

Sich Eine ◽

Fand Sich ◽

India Ink ◽

Hemikolektomie Rechts

Die laparoskopische Kolonchirurgie benötigt oft als unterstützende Massnahme eine präoperative Markierung der Läsion, da dem Chirurgen die intraoperative orientierende Palpation fehlt. Die endoskopische Markierung mit Tusche ist aufgrund der Einfachheit und der langanhaltenden Markierung die Methode der Wahl. Nur wenige Komplikationen sind bei dieser Technik beschrieben. In unserem Fall traten im Anschluss an die Markierung einer idiopathischen ulzerösen Kolonveränderung progrediente Bauchschmerzen auf. Bei der Operation fand sich eine retroperitoneale gedeckte Perforation. Die entzündlichen Veränderungen waren derart, dass ein laparoskopisches Vorgehen unmöglich war und eine offene Hemikolektomie rechts notwendig war. Bei Fieber, Abdominalschmerzen und Zeichen der lokalen Peritonitis im Anschluss an eine endoskopische Tuschmarkierung muss an eine unerwünschte Reaktion auf die Tusche gedacht werden.

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ENDOSCOPIC LINE-ASSISTED COMPLETE CLOSURE OF LARGE COLONIC PERFORATION DURING ENDOSCOPIC SUBMUCOSAL DISSECTION

10.1055/s-0039-1681365 ◽

2019 ◽

Author(s):

B Agudo ◽

D De Frutos ◽

J Santiago ◽

I González ◽

M González-Haba ◽

...

Keyword(s):

Endoscopic Submucosal Dissection ◽

Colonic Perforation ◽

Submucosal Dissection ◽

Complete Closure

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Survival case of acute and severe respiratory distress due to spontaneous tension gastrothorax

BMJ Case Reports ◽

10.1136/bcr-2020-235281 ◽

2020 ◽

Vol 13 (9) ◽

pp. e235281

Author(s):

Sanjan Asanaru Kunju ◽

Prithvishree Ravindra ◽

Ramya Kumar Madabushi Vijay ◽

Priya Pattath Sankaran

Keyword(s):

Tension Pneumothorax ◽

Emergency Laparotomy ◽

Severe Respiratory Distress ◽

Mediastinal Shift ◽

Breath Sounds ◽

Chest X Ray ◽

The Right ◽

Tension Gastrothorax ◽

Obstructive Shock ◽

Survival Case

A 20-year-old woman presented with abdominal pain and shortness of breath. She was in obstructive shock with absent breath sounds on the left haemithorax. Chest X-ray showed a large radiolucent shadow with absent lung markings and mediastinal shift to the right side with concerns for tension pneumothorax. Though tube thoracostomy was done on the left side of the chest, column movement was absent. To confirm the diagnosis CT with contrast was done that revealed a huge left side diaphragmatic defect with abdominal contents in the thorax and mediastinal structures are shifted to left. She underwent emergency laparotomy and postoperative period was uneventful.

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Two cases of intraoperative hemodynamic instability during combined thoracoscopic-laparoscopic surgery for esophagogastric junction carcinoma

JA Clinical Reports ◽

10.1186/s40981-021-00419-x ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Makiko Tani ◽

Yoshikazu Matsuoka ◽

Mayu Sugihara ◽

Ayaka Fujii ◽

Tomoyuki Kanazawa ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Esophagogastric Junction ◽

Intraoperative Complications ◽

Proximal Gastrectomy ◽

Tension Pneumothorax ◽

Hemodynamic Instability ◽

Laparoscopic Proximal Gastrectomy ◽

Surgical Field ◽

Coronary Ischemia ◽

Thoracic And Abdominal

Abstract Background Intraoperative complications during combined thoracoscopic-laparoscopic surgery for esophagogastric junction (EGJ) carcinoma have not been reported as compared to those during surgery for esophageal carcinoma. We present two cases which had surgery-related hemodynamic instability during laparoscopic proximal gastrectomy and intra-mediastinal valvuloplastic esophagogastrostomy (vEG) with thoracoscopic mediastinal lymphadenectomy for EGJ carcinoma. Case presentation In case 1, the patient fell into hypotension with hypoxemia during laparoscopic vEG due to pneumothorax caused by entry of intraabdominal carbon dioxide. In case 2, ventricular arrythmia and ST elevation occurred during laparoscopic vEG. Pericardium retraction to secure surgical field during reconstruction compressed the coronary artery, which caused coronary malperfusion. These two events were induced by the surgical procedure, characterized by the following: (1) connection of the thoracic and abdominal cavities and (2) cardiac displacement during vEG. Conclusion These cases indicated tension pneumothorax and coronary ischemia are possible intraoperative complications specific to combined thoracoscopic-laparoscopic surgery for EGJ carcinoma.

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Colonic perforation following major burns: Experience from a burns center and a systematic review

Burns ◽

10.1016/j.burns.2021.04.018 ◽

2021 ◽

Author(s):

Michael G. Fadel ◽

Mohamad Iskandarani ◽

Joshua Cuddihy ◽

Isabel Jones ◽

Declan Collins ◽

...

Keyword(s):

Systematic Review ◽

Colonic Perforation

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Facility of Origin Predicts Mortality After Colonic Perforation

The American Surgeon ◽

10.1177/0003134820971623 ◽

2020 ◽

pp. 000313482097162

Author(s):

Samuel D. Butensky ◽

Emma Gazzara ◽

Gainosuke Sugiyama ◽

Gene F. Coppa ◽

Antonio Alfonso ◽

...

Keyword(s):

Logistic Regression ◽

Chronic Care ◽

Care Facility ◽

Colonic Perforation ◽

Risk Of Death ◽

Increased Risk ◽

Chronic Care Facility ◽

Partial Colectomy ◽

Emergent Surgery ◽

Perforated Viscus

Introduction Colonic perforation often requires emergent intervention and carries high morbidity and mortality. The objective of this study was to determine whether nonclinical factors, such as transition of care from outpatient facilities to inpatient settings, are associated with increased risk of mortality in patients who underwent emergent surgical intervention for colonic perforation. Materials and Methods Using the 2006-2015 ACS National Surgical Quality Improvement Program database, we identified adult patients who underwent emergent partial colectomy with primary anastomosis ± protecting ostomy or partial colectomy with ostomy with intraoperative finding of wound class III or IV for a diagnosis of perforated viscus. The outcome of interest was 30-day postoperative mortality. Univariate and multivariate analyses using logistic regression were performed. Results 4705 patients met criteria, of which 841 (17.9%) died. Univariate analysis showed that patients who died after emergent surgery for perforated viscus were more likely to present from a chronic care facility (13.4% vs. 4.4%, P < .0001) and had longer time from admission to undergoing surgery (mean 4.1 vs. 2.0 days, P < .0001. Logistic regression demonstrated that septic shock vs. none (OR 3.60, P < .0001), sepsis vs. none (OR 1.57, P = .00045), transfer from chronic care facility vs. home (OR 1.87, P < .0001), and increased time from admission vs. operation (OR 1.01, P = .0055) were independently associated with increased risk of death. Discussion Transfer from a chronic care facility was independently associated with increased mortality in patients undergoing emergent surgery for perforated viscus.

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Tension Pneumothorax in Prehospital Setting

Prehospital and Disaster Medicine ◽

10.1017/s1049023x21000479 ◽

2021 ◽

pp. 1-1

Author(s):

Yagmur Ay ◽

Mustafa Emin Canakci

Keyword(s):

Tension Pneumothorax ◽

Prehospital Setting

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A comparison of the demographics, injury patterns and outcome data for patients injured in motor vehicle collisions who are trapped compared to those patients who are not trapped

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-020-00818-6 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Tim Nutbeam ◽

Rob Fenwick ◽

Jason Smith ◽

Omar Bouamra ◽

Lee Wallis ◽

...

Keyword(s):

Spinal Cord ◽

Blood Loss ◽

Injury Severity ◽

Spinal Cord Injuries ◽

Motor Vehicle ◽

Tension Pneumothorax ◽

Research Network ◽

Motor Vehicle Collisions ◽

Vehicle Collisions ◽

Time Critical

Abstract Background Motor vehicle collisions (MVCs) are a common cause of major trauma and death. Following an MVC, up to 40% of patients will be trapped in their vehicle. Extrication methods are focused on the prevention of secondary spinal injury through movement minimisation and mitigation. This approach is time consuming and patients may have time-critical injuries. The purpose of this study is to describe the outcomes and injuries of those trapped following an MVC: this will help guide meaningful patient-focused interventions and future extrication strategies. Methods We undertook a retrospective database study using the Trauma Audit and Research Network database. Patients were included if they were admitted to an English hospital following an MVC from 2012 to 2018. Patients were excluded when their outcomes were not known or if they were secondary transfers. Results This analysis identified 426,135 cases of which 63,625 patients were included: 6983 trapped and 56,642 not trapped. Trapped patients had a higher mortality (8.9% vs 5.0%, p < 0.001). Spinal cord injuries were rare (0.71% of all extrications) but frequently (50.1%) associated with other severe injuries. Spinal cord injuries were more common in patients who were trapped (p < 0.001). Injury Severity Score (ISS) was higher in the trapped group 18 (IQR 10–29) vs 13 (IQR 9–22). Trapped patients had more deranged physiology with lower blood pressures, lower oxygen saturations and lower Glasgow Coma Scale, GCS (all p < 0.001). Trapped patients had more significant injuries of the head chest, abdomen and spine (all p < 0.001) and an increased rate of pelvic injures with significant blood loss, blood loss from other areas or tension pneumothorax (all p < 0.001). Conclusion Trapped patients are more likely to die than those who are not trapped. The frequency of spinal cord injuries is low, accounting for < 0.7% of all patients extricated. Patients who are trapped are more likely to have time-critical injuries requiring intervention. Extrication takes time and when considering the frequency, type and severity of injuries reported here, the benefit of movement minimisation may be outweighed by the additional time taken. Improved extrication strategies should be developed which are evidence-based and allow for the expedient management of other life-threatening injuries.

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