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      Massive Pneumoperitoneum after Bronchoscopy and Noninvasive Ventilation in a COVID-19 Patient, without Associated Pneumomediastinum or Pneumothorax


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          A bstract

          The most common cause of pneumoperitoneum is a perforated hollow viscus. However, there are other causes that have been termed nonsurgical, asymptomatic, benign, or idiopathic pneumoperitoneum, most of them of thoracic origin; these are due to complications caused by invasive mechanical ventilation or interventional procedures such as fiberoptic bronchoscopy and are accompanied by pneumomediastinum, pneumothorax, or both. We present a case of isolated massive pneumoperitoneum, without accompanying pneumothorax or pneumomediastinum, in a patient with bilateral bronchopneumonia due to coronavirus disease 2019 (COVID-19) already cured and who underwent urgent bronchoscopy due to hemoptysis. This is a rather exceptional case due to barotrauma after noninvasive ventilation, and in whose pathophysiological mechanism both bronchoscopy and possible pulmonary fibrosis resulting from bilateral COVID-19 pneumonia may also have played a role.

          How to cite this article

          Tudela M, Fernandez M, Turegano F. Massive Pneumoperitoneum after Bronchoscopy and Noninvasive Ventilation in a COVID-19 Patient, without Associated Pneumomediastinum or Pneumothorax. Panam J Trauma Crit Care Emerg Surg 2020;9(2):162–164.


          La causa más frecuente de neumoperitoneo es la perforación de una víscera hueca. Sin embargo, existen otras causas a las que se ha denominado neumoperitoneo no quirúrgico, asintomático, benigno o idiopático, entre las que destacan las de origen torácico; éstas se deben a una complicación de la ventilación mecánica invasiva o a procedimientos intervencionistas como la fibrobroncoscopia, y se acompañan de neumomediastino, neumotórax o de ambos. Presentamos un caso de neumoperitoneo aislado masivo, sin neumotórax ni neumomediastino acompañantes, en un paciente con bronconeumonía bilateral por Covid-19 ya curada y que fue sometido a fibrobroncoscopia urgente por hemoptisis. Se trata de un caso excepcional por el posible barotrauma tras ventilación no invasiva, y en cuyo mecanismo fisiopatológico pudieron estar implicados también la fibrobroncoscopia y la posible fibrosis pulmonar resultante de la neumonía bilateral por Covid-19.

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          Most cited references9

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          The role of epidermal growth factor receptor (EGFR) signaling in SARS coronavirus-induced pulmonary fibrosis

          Many survivors of the 2003 outbreak of severe acute respiratory syndrome (SARS) developed residual pulmonary fibrosis with increased severity seen in older patients. Autopsies of patients that died from SARS also showed fibrosis to varying extents. Pulmonary fibrosis can be occasionally seen as a consequence to several respiratory viral infections but is much more common after a SARS coronavirus (SARS-CoV) infection. Given the threat of future outbreaks of severe coronavirus disease, including Middle East respiratory syndrome (MERS), it is important to understand the mechanisms responsible for pulmonary fibrosis, so as to support the development of therapeutic countermeasures and mitigate sequelae of infection. In this article, we summarize pulmonary fibrotic changes observed after a SARS-CoV infection, discuss the extent to which other respiratory viruses induce fibrosis, describe available animal models to study the development of SARS-CoV induced fibrosis and review evidence that pulmonary fibrosis is caused by a hyperactive host response to lung injury mediated by epidermal growth factor receptor (EGFR) signaling. We summarize work from our group and others indicating that inhibiting EGFR signaling may prevent an excessive fibrotic response to SARS-CoV and other respiratory viral infections and propose directions for future research.
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            Complications of bronchoscopy: A concise synopsis

            Flexible and rigid bronchoscopes are used in diagnosis, therapeutics, and palliation. While their use is widespread, effective, and generally safe; there are numerous potential complications that can occur. Mechanical complications of bronchoscopy are primarily related to airway manipulations or bleeding. Systemic complications arise from the procedure itself, medication administration (primarily sedation), or patient comorbidities. Attributable mortality rates remain low at < 0.1% for fiberoptic and rigid bronchoscopy. Here we review the complications (classified as mechanical or systemic) of both rigid and flexible bronchoscopy in hope of making practitioners who are operators of these tools, and those who consult others for interventions, aware of potential problems, and pitfalls in order to enhance patient safety and comfort.
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              Non‐surgical pneumoperitoneum associated with mechanical ventilation


                Author and article information

                Panamerican Journal of Trauma, Critical Care & Emergency Surgery
                Jaypee Brothers Medical Publishers
                May-August 2020
                : 9
                : 2
                : 162-164
                [1 ]Department of Gastrointestinal Surgery, University General Hospital Gregorio Marañón, Madrid, Spain
                [2,3 ]Department of Emergency Surgery, University General Hospital Gregorio Marañón, Madrid, Spain
                Author notes
                Maria Tudela, Department of Gastrointestinal Surgery, University General Hospital Gregorio Marañón, Madrid, Spain, Phone: +34 619552562, e-mail: matuler@ 123456hotmail.com
                Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.

                © The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Custom metadata

                General medicine,Immunology,Health & Social care,Public health,Infectious disease & Microbiology,Microbiology & Virology
                Pathophysiological mechanism,Mecanismo fisiopatológico,Neumoperitoneo,Neumotórax,Barotrauma,Bilateral bronchopneumonia,COVID-19,Pneumoperitoneum,Pneumothorax,Bronconeumonía bilateral


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