Anesth Pain Med.  2020 Jul;15(3):383-387. 10.17085/apm.20034.

Invisible perforation during an endoscopic procedure of the esophagus under general anesthesia - A case report -

• Heo HJ
• Lee JH
• Kim YY
• Baek SM
• Kim KM
• Jung DW

• KMID: 2504903
• DOI: http://doi.org/10.17085/apm.20034

Abstract

Background
Endoscopic procedures of the esophagus are more complicated than those of other regions of the gastrointestinal tract. They have a relatively long procedure time and high risk of complications, such as perforation and bleeding. Perforations that occur during the procedure can accompany pneumoperitoneum and pneumomediastinum through leakage of insufflation air and cause severe ventilatory impairment. Case: A 58-year-old male patient underwent enucleation of leiomyoma in the esophagus using endoscopy under general anesthesia. Ventilatory impairment occurred 15 min after commencement of the procedure. Subsequently, subcutaneous emphysema and severe abdominal distension were observed. We suggested the possibility of microperforation during the procedure to the endoscopist, and he performed endoscopic clipping around the excision site of leiomyoma.
Conclusions
Providing anesthetic care by anesthesiologists during endoscopic procedures is considered necessary for patient safety. Complications of endoscopic procedures can be detected and managed early without sequelae during anesthetic care.

Keyword

Endoscopy; Esophagus; General anesthesia; Perforation; Pneumomediastinum; Pneumoperitoneum

Figure

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  Fig. 1. Endoscopic submucosal tunnel resection. (A) Submucosal esophageal leiomyoma. (B) Submucosal space after removal of leiomyoma. (C and D) Clipping of the esophageal mucosa.

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  Fig. 2. Chest radiographs. (A) Endoscopic submucosal tunnel leiomyoma resection shows pneumoperitoneum (arrows), pneumomediastinum (arrowheads), and generalized subcutaneous emphysema. (B) On postprocedural day 1, pneumoperitoneum has disappeared, but pneumomediastinum (arrowheads) and subcutaneous emphysema have persisted.

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