Int J Gastrointest Interv.  2022 Jul;11(3):139-142. 10.18528/ijgii210057.

A rare complication: Tension pneumothorax after peroral endoscopic myotomy

• Kang S
• Kim Y
• Kim DH

• KMID: 2532315
• DOI: http://doi.org/10.18528/ijgii210057

Abstract

Peroral endoscopic myotomy (POEM) can be safely performed for achalasia. During POEM, gas is insufflated via the endoscope inside the submucosal tunnel. Gas-related complications often cannot be avoided because of the lack of serosa in the esophagus and the inability of the adventitia to function as a resistant barrier to gas. However, tension pneumothorax causing respiratory failure is a rare complication of POEM. Herein, we describe a 32-year-old female who developed tension pneumothorax after POEM. She showed respiratory compromise after POEM, and emergency chest radiography revealed pneumothorax with mediastinal shift. Tension pneumothorax was managed by chest tube drainage with the application of negative-suction pressure via the tube, after which her vital signs stabilized. On post-procedural day 4, the tube was removed. Our case suggests the importance of considering tension pneumothorax if respiratory compromise occurs despite oxygen administration after POEM even in the absence of immediate complications during the procedure, and performing chest radiography promptly.

Keyword

Esophageal achalasia; Myotomy; Pneumothorax