Tension pneumoperitoneum: a rare complication of upper gastrointestinal endoscopy

Tension pneumoperitoneum is defined as the massive accumulation of air in the peritoneal cavity, which results in a sudden increase in intraabdominal pressure. Various iatrogenic procedures are responsible for this complication. We herein report a case of tension pneumoperitoneum resulting from upper gastrointestinal endoscopy. A 45-y-old man was referred to our department because of melena. Esophagogastroscopy was unsuccessful because of failure to inflate the stomach, and sudden abdominal distension was noted immediately after the procedure. The hemodynamic status of the patient was compromised, and the imminent collapse was prevented with emergent needle paracentesis. Decompression of the abdominal cavity restored vital signs to normal allowing definitive surgical treatment. Upper gastrointestinal endoscopy is a rare cause of this life-threatening complication. The combination of acute abdominal distension with hemodynamic instability following endoscopic procedures should raise suspicion of tension pneumoperitoneum. Needle decompression is life-saving and should be performed instantly upon recognition of this condition.