Pneumoperitoneum Post Esophageal Stent Insertion Managed With Paracentesis.

Gastrointestinal tract perforation is a known complication of endoscopy and may present itself as a pneumoperitoneum, pneumomediastinum or less commonly subcutaneous emphysema. Due to high insufflation pressures, barotrauma or mechanical trauma may result in a large pneumoperitoneum; however, the leak may spontaneously seal once insufflation has ceased. While unwell and peritonitic patients require prompt surgical intervention, in many cases patients may be clinically stable and respond appropriately to conservative management. We present the case of pneumoperitoneum post esophageal stent insertion for management of malignant dysphagia in a 74-year-old female patient. She experienced severe epigastric pain immediately post procedure and on image confirmation of a pneumoperitoneum underwent a paracentesis with significant pain relief and was then successfully managed conservatively. This case highlights that paracentesis may provide significant symptomatic relief from decompression of intra-abdominal free gas and facilitate non-operative management of pneumoperitoneum post upper gastrointestinal tract endoscopy.

Pneumatosis Cystoides Intestinalis: A Benign Cause of Pneumoperitoneum.

Pneumatosis cystoides intestinalis (PCI) is an uncommon condition where cyst-like locules of gas are present in the submucosa or subserosa of the gastrointestinal tract. The majority of cases are benign and are associated with drugs such as chemotherapy agents or conditions including chronic obstructive airways disease. We present the case of PCI resulting in pneumoperitoneum in a 72-year-old male patient on chemotherapy for esophageal adenocarcinoma. While he was noted to have an extensive pneumoperitoneum and mesenteric emphysema on imaging, he remained clinically stable with a benign abdominal examination and was managed conservatively with intravenous antibiotics and fluids. This case highlights the importance of benign PCI as a differential to bowel ischemia in patients with pneumatosis intestinalis and pneumoperitoneum, particularly given the possibility of avoiding operative management and the resultant morbidity.