A rare complication: Tension pneumothorax after peroral endoscopic myotomy
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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.
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.
참고문헌 (20)
- Inoue H, "Peroral endoscopic myotomy(POEM)for esophageal achalasia", Endoscopy, 42, pp.265~271 (2010)
- 윤영훈, "Peroral Endoscopic Myotomy for Treating Achalasia and Esophageal Motility Disorders", Journal of Neurogastroenterology and Motility (JNM), 22(1), pp.14~24 (2016), 대한소화기 기능성질환∙운동학회[DOI]
- 김준영, "Peroral Endoscopic Myotomy for Esophageal Motility Disorders", Clinical Endoscopy, 53(6), pp.638~645 (2020), 대한소화기내시경학회[DOI]
- Inoue H, "Per-oral endoscopic myotomy : a series of 500 patients", J Am Coll Surg, 221, pp.256~264 (2015)
- Shiwaku H, "Multicenter collaborative retrospective evaluation of peroral endoscopic myotomy for esophageal achalasia : analysis of data from more than 1300 patients at eight facilities in Japan", Surg Endosc, 34, pp.464~468 (2020)
- Dirks RC, "Is peroral endoscopic myotomy (POEM) more effective than pneumatic dilation and Heller myotomy? A systematic review and meta-analysis", Surg Endosc, 35, pp.1949~1962 (2021)
- Wang X, "Risk factors for gas-related complications of peroral endoscopic myotomy in achalasia", Neth J Med, 73, pp.76~81 (2015)
- Young Kwan Cho, "Current Status of Peroral Endoscopic Myotomy", Clinical Endoscopy, 51(1), pp.13~18 (2018), 대한소화기내시경학회
- Nabi Z, "Adverse events during and after per-oral endoscopic myotomy : prevention, diagnosis, and management", Gastrointest Endosc, 87, pp.4~17 (2018)
- Akintoye E, "Peroral endoscopic myotomy : a meta-analysis", Endoscopy, 48, pp.1059~1068 (2016)
- Samo S, "Incidence and prevalence of achalasia in central Chicago, 2004-2014, since the widespread use of high-resolution manometry", Clin Gastroenterol Hepatol, 15, pp.366~373 (2017)
- Reynolds JC, "Achalasia", Gastroenterol Clin North Am, 18, pp.223~255 (1989)
- Boeckxstaens GE, "Achalasia", Lancet, 383, pp.83~93 (2014)
- Yang S, "Pneumomediastinum and pneumoperitoneum on computed tomography after peroral endoscopic myotomy(POEM) : postoperative changes or complications?", Acta Radiol, 56, pp.1216~1221 (2015)
- Gong Y, "Pneumothorax, pneumomediastinum, and pneumoperitoneum during peroral endoscopic myotomy under general anesthesiaa case report", Int J Clin Exp Med, 9, pp.6943~6946 (2016)
- Rajmohan N, "Problems in beginning a"POEM"", Indian J Anaesth, 63, pp.508~510 (2019)
- Roberts DJ, "Clinical presentation of patients with tension pneumothorax : a systematic review", Ann Surg, 261, pp.1068~1078 (2015)
- Roberts DJ, "Clinical manifestations of tension pneumothorax : protocol for a systematic review and meta-analysis", Syst Rev, 3, pp.3~ (2014)
- Leigh-Smith S, "Tension pneumothorax--time for a re-think?", Emerg Med J, 22, pp.8~16 (2005)
- Li TS, "Tension pneumothorax during peroral endoscopic myotomy for treatment of esophageal achalasia under general anesthesia", Rev Bras Anestesiol, 67, pp.415~417 (2017)