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

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.

RESUMEN

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.