Unusual and rare manifestations after bronchoscopy: Pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum—Case report

Introduction: Pneumoperitoneum, pneumoretroperitoneum, and pneumomediastinum are rare findings in the absence of visceral perforation or trauma. While often asymptomatic, these conditions can complicate clinical decision-making, particularly when they occur after endoscopic procedures such as bronchoscopy. Typically caused by barotrauma, air leakage in such cases is often explained by the Macklin effect—a phenomenon where air dissects through the interstitial tissues following alveolar rupture. Although flexible bronchoscopy is generally considered a safe procedure, timely recognition of these complications is essential to prevent adverse outcomes. Medical imaging, especially computed tomography (CT), plays a vital role in diagnosing these conditions, evaluating associated complications, and identifying potential underlying causes such as perforation. Case Report: We report the case of a 17-year-old female patient hospitalized for surgical management of a left pulmonary hydatid cyst. Following a diagnostic bronchoscopy, the patient developed pneumomediastinum, pneumoperitoneum, and pneumoretroperitoneum. Imaging studies were instrumental in the rapid identification of these rare complications. Despite radiological findings suggestive of visceral perforation, further endoscopic evaluations revealed no injury to the esophageal, digestive, or bronchial structures. The patient was admitted to the intensive care unit for close monitoring due to an initially unstable clinical condition. The management was conservative, and the patient’s condition improved progressively. He was discharged without any further complications. Conclusion: This case highlights the importance of imaging in the diagnosis and monitoring of rare complications following bronchoscopy. Even in the absence of overt visceral injury, clinicians should be aware of these potential presentations to ensure prompt and appropriate management.