Clin Endosc.  2015 Nov;48(6):566-569. 10.5946/ce.2015.48.6.566.

Delayed Pneumoperitoneum and Acute Pulmonary Edema Secondary to Acute Gastric Dilatation

• Ahn JY
• Kim JK

• KMID: 2380418
• DOI: http://doi.org/10.5946/ce.2015.48.6.566

Abstract

Pneumoperitoneum caused by acute gastric dilatation (AGD) is a very rare complication. We report a case of pneumoperitoneum and acute pulmonary edema caused by AGD in a patient with Parkinson's disease. A 78-year-old woman presented with pneumonia and AGD. We inserted a nasogastric tube and administered empirical antibiotics. We performed an endoscopy, and perforation or necrosis of the stomach and pyloric stenosis were not observed. Thirty-six hours after admission, the patient suddenly developed dyspnea and shock, and eventually died. We suspected the cause of death was pneumoperitoneum and acute pulmonary edema caused by AGD during the conservative treatment period. Immunocompromised patients with chronic illness require close observation even if they do not show any symptoms suggestive of complications. Even if the initial endoscopic or abdominal radiologic findings do not show gastric necrosis or perforation, follow-up with endoscopy is essential to recognize complications of AGD early.

Keyword

Acute gastric dilatation; Pneumoperitoneum; Acute pulmonary edema

MeSH Terms

Aged
Anti-Bacterial Agents
Cause of Death
Chronic Disease
Dyspnea
Endoscopy
Female
Follow-Up Studies
Gastric Dilatation*
Humans
Immunocompromised Host
Necrosis
Parkinson Disease
Pneumonia
Pneumoperitoneum*
Pulmonary Edema*
Pyloric Stenosis
Shock
Stomach
Anti-Bacterial Agents

Figure

• 

  Fig. 1. Noncontrast computed tomography scan of the patient. (A) Pneumonic consolidation is seen in the left lower lobe of the lung. (B) Abdominal computed tomography scan showing a severely dilated stomach with fluid retention and absence of free air in the abdomen.

• 

  Fig. 2. Esophagogastroduodenoscopic images. (A) There is a large volume of remnant food and liquid materials and multiple superficial ulcers and erosions over the entire wall of the stomach. (B) No evidence of duodenal ulcer or pyloric obstruction is visible.

• 

  Fig. 3. Radiograph at 36 hours follow-up. The image shows the pneumoperitoneum and increased infiltration in both lung fields.

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