Tension pneumoperitoneum resulting from endoscopic duodenal perforation: a case report.

Tension pneumoperitoneum is defined as an accumulation of free air within the peritoneal cavity sufficient to cause respiratory or hemodynamic compromise. We report a case of a 75-year-old woman who underwent upper endoscopy for evaluation of severe upper gastrointestinal hemorrhage. During the procedure, she developed massive abdominal distension, raising concern about possible perforation. Endoscopy was terminated and prompt surgical consultation obtained. This revealed massive abdominal distension, hypotension, and elevated airway pressures. Tension pneumoperitoneum was suspected. There was immediate decompression via a small umbilical incision, after which the patient's condition stabilized. A full exploration was then carried out, allowing definitive surgical treatment of both the source of bleeding and the perforation. We review the literature regarding this unusual event.