Lebensbedrohliches Spannungs-Pneumoperitoneum

Beside retained postoperative air, many interventions on critically ill patients may cause pneumoperitoneum. Tension pneumoperitoneum is an unfamiliar but life threatening complication. It must be immediately diagnosed (usually clinical) and decompression of the abdomen is mandatory. Tension pneumoperitoneum can occur in association with gastrointestinal endoscopies, abdominal surgery, abdominal trauma, cardiopulmonary resuscitation, mechanical ventilation and idiopathically. The mortality is high, being 30-80%. The amount of the pneumoperitoneum with its elevation of the intraabdominal pressure determines the cardiovascular and pulmonary compromise. We report a patient presenting with tension pneumoperitoneum during colonoscopic decompression of a drug resistant constipation.