We report a case of massive pneumoperitoneum with bowel perforation after a bronchoscopy.
A 67-year-old male patient, with a history of Gastric Sleeve in 2007 due to morbid obesity. Under examination due to pulmonary nodules. A bronchoscopy was performed for the study and biopsy of the pulmonary nodules.
He subsequently presented with severe abdominal pain and respiratory distress. In the emergency room, an abdomen x-ray was performed, finding a massive pneumoperitoneum.(FIG1)
As a result, an abdominal CT was performed, showing a pneumoperitoneum with intestinal perforation by jejunal diverticulum perforation. There was a marked engorgement of the wall of the first jejunal loop, which was hypocaptive and displayed air in the wall, with an edematous mesenterium. (FIG2, FIG3)
We decided to perform an emergency surgery.
We performed an exploratory laparoscopy, finding 60 cm of ischemic jejunum . We resected the damaged bowel an a latero-lateral anastomosis was performed. (FIG4)
The patient had a correct evolution, starting oral intake on day 3 and was discharged 5 days after surgery.