Tension pneumoperitoneum

Tension Pneumoperitoneum: A Rare Complication of Cardiopulmonary Resuscitation (CPR)

Tension pneumoperitoneum is a surgical emergency. Although rare, failure to diagnose and treat the condition may be lethal. Hence, being aware of this phenomenon, particularly in scenarios involving cardiopulmonary resuscitation (CPR), is important. Existing literature emphasises immediate abdominal needle decompression as the initial management followed by close monitoring and keeping a low threshold for surgical intervention as a definitive measure. We decided to write up this case report to raise awareness that a tension pneumoperitoneum can result as a complication of CPR, a well-known and widely practiced algorithm.

Tension pneumoperitoneum caused by blunt trauma

Tension pneumoperitoneum (TPP), the accumulation of free intraabdominal air under pressure, is a rare event. TPP usually occurs from bowel surgery or bowel perforations. Less commonly, TPP occurs in the presence of pneumothoraces or during positive pressure ventilation. Trauma has rarely been a reported cause of TPP. The cases of 2 patients with TPP after blunt trauma are reported. The pathophysiology and management of TPP are discussed.

Tension pneumoperitoneum after heart-lung transplantation

Tension pneumoperitoneum is a medical emergency. We report 2 cases in which tension pneumoperitoneum occurred after heart-lung transplantation and was related to positive-pressure ventilation and a transdiaphragmatic passage of omentum used to wrap the airway anastomosis. Management in these patients was targeted toward decompression of intraperitoneal air with percutaneous needle or tube placement without exploratory laparotomy, and tube thoracostomy for the concomitant pneumothorax.