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Tension pneumoperitoneum
  1. Giovanni Ferrara1,
  2. Venkata Satish Kolli2,
  3. Stefan Arnaudov2,
  4. Graham Whiteley2
  1. 1Department of Anaesthetics, Betsi Cadwaladr University Health Board, Bangor, UK
  2. 2Department of Surgery, Betsi Cadwaladr University Health Board, Bangor, UK
  1. Correspondence to Dr Giovanni Ferrara, giovanni.ferrara{at}


A 35-year-old man stopped breathing after injecting a large dose of heroin. He subsequently received cardiopulmonary resuscitation from friends. He arrived to accident and emergency department with Glasgow Coma Scale of 13. On examination, he had distended and tense abdomen. CT Thorax, Abdomen, and Pelvis confirmed massive tension pneumoperitoneum. A 14 Fr intravenous cannula was inserted through the umbilicus to relieve the intra-abdominal pressure. An emergency laparotomy showed petechia along the anterior gastric wall, haematoma of lesser omentum but showed no evidence of gastrointestinal perforation or organ injury. Air leak test performed by insufflating air into the stomach via nasogastric tube and abdomen filled with normal saline showed no leak. On-table oesophagogastroduodenoscopy showed mild oesophagitis and petechia of cardiac gastric mucosa. He was treated with intravenous antibiotics and discharged on the fifth postoperative day with adequate analgesia.

  • gastrointestinal surgery
  • general surgery

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  • Contributors GW conceived of the case report. GF, VSK and SA reviewed the literature. GF wrote the first draft and synthesis of the case report. All authors cared for the patient and contributed to refinement of the final manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.