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Perforation of the colon occurs in 0.2 to 2% of all colonoscopic examinations. The most common sites of perforation are rectosigmoid junction and cecal area. Colonic perforation, leading to tension pneumoperitoneum in most cases, may be caused by direct trauma or pressurized air. It should be suspected in patients with hypotension, tachycardia and tachypnea during or after the colonoscopy. An 83-year-old woman was admitted due to pulmonary embolism and left cerebellar infarction. Colonoscopy was performed due to bloody diarrhea. She was diagnosed as cytomegalovirus (CMV) colitis. One week after the colonoscopy, colon perforation was incidentally found on ascending colon, and tension pneumoperitoneum occurred immediately after the procedure. The perforated site was primarily closed and the patient discharged 20 days later. Herein, we report a case of tension pneumoperitoneum following colonoscopy in a patient with CMV colitis.
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Cureus
July 2025
Surgery, Hospital General de Zona 1, Instituto Mexicano del Seguro Social, Tepic, MEX.
Complex ventral hernias pose a significant surgical challenge, particularly those with large defects or loss of domain. Traditional techniques may be associated with high complication rates or insufficient defect coverage. The modified Carbonell-Bonafé anatomical component separation (ACS) technique offers an innovative approach to achieve tension-free closure and functional abdominal wall reconstruction.
View Article and Find Full Text PDFCureus
August 2025
Department of Anesthesia, Perioperative Medicine, and Pain Management, University of Miami, Miami, USA.
Patients with severe emphysematous bullae present significant anesthetic challenges, especially during laparoscopic or robotic-assisted surgeries, where positive pressure ventilation and pneumoperitoneum increase the risk of barotrauma. Rupture of a bulla can cause life-threatening tension pneumothorax, and intervention may be delayed in robotic cases due to limited access. A 62-year-old male patient with chronic obstructive pulmonary disease (COPD) and extensive bilateral bullous disease was scheduled for robotic-assisted laparoscopic inguinal hernia repair.
View Article and Find Full Text PDFHernia
June 2025
Department of General Surgery, York Abdominal Wall Unit, York and Scarborough Teaching Hospitals NHSFT, 4th Floor, Administrative Block, Wigginton Road, Clifton, York, YO31 8HE, UK.
Background: Complex Abdominal Wall Reconstruction (CAWR) in patients with significant loss of domain poses substantial surgical and physiological challenges [1], [2]. Preoperative Progressive Pneumoperitoneum (PPP), involving incremental insufflation of gas into the abdominal cavity, enhances the likelihood of tension-free fascial closure [3]. However, there remains considerable variability and incompleteness in existing PPP protocols, especially concerning venous thromboembolism (VTE) prophylaxis, inferior vena cava (IVC) filter placement, respiratory prehabilitation, and multidisciplinary coordination.
View Article and Find Full Text PDFWorld J Surg
July 2025
Womack Army Medical Center, Fort Bragg, North Carolina, USA.
Introduction: Tension pneumoperitoneum (TPP) is a rare but life-threatening condition characterized by free intraperitoneal air causing intra-abdominal hypertension and hemodynamic compromise. It shares physiologic features with abdominal compartment syndrome and requires timely recognition and intervention. This systematic clinical review evaluates the presentation, diagnostic strategies, management approaches, and outcomes associated with TPP.
View Article and Find Full Text PDFJ Emerg Med
March 2025
Division of Emergency Medicine, Department of Surgery, Saint Louis University School of Medicine, St. Louis, Missouri.
Background: Tension pneumoperitoneum (TPP) is a rare but life-threatening pathology in which significant accumulation of free air in the peritoneum pressurizes the abdominal cavity, creating conditions similar to abdominal compartment syndrome. Due to compression of intra-abdominal vasculature, TPP results in hemodynamic instability. While it most commonly occurs due to viscus perforation in the setting of recent endoscopy, gastric perforation from resuscitative efforts can also lead to TPP.
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