Severe pneumoperitoneum, mediastinal emphysema, and thoracoabdominal wall emphysema during flexible bronchoscopy: a case report

This case presents a rare complication that occurred during flexible bronchoscopy, including severe pneumoperitoneum, mediastinal emphysema, and thoracoabdominal wall emphysema. This study provides a profound analysis of the most probable causes of the aforementioned complications, hoping to offer some valuable insights for clinical practice. The patient developed abdominal distension, abdominal bulge, decreased oxygen saturation, and hemodynamic instability during flexible bronchoscopy under intravenous anesthesia with oxygen delivery via a nasopharyngeal oxygen cannula at a flow rate of 5 L/min. Following a multidisciplinary resuscitation procedure involving the insertion of an endotracheal tube, the administration of vasoactive medications, and the performance of an abdominal paracentesis, the patient's condition demonstrated signs of stabilisation. Imaging studies revealed pneumoperitoneum, mediastinal emphysema, and thoracoabdominal wall emphysema, but no pneumothorax was observed. Additionally, no endoscopically visible gastrointestinal perforation was detected. The patient was finally discharged after improvement with conservative treatment. This report aims to explore the potential mechanisms and management strategies for this rare complication, highlighting the need for vigilance against barotrauma and careful management of oxygen delivery methods during bronchoscopy.