Tension pneumothorax complicating diagnostic upper endoscopy: A case report

Hypoxemia is common during various endoscopic procedures and may result fro m a variety of causes. These causes range from benign and otherwise easily reversible events like oversedation to potentially life threatening complic ations such as pneumothorax. Although pneumothorax has been reported second ary to gastrointestinal perforation as a complication of various therapeuti c endoscopic procedures, there has been no report of pneumothorax without p erforation. We report a case of a patient who developed severe hypoxemia an d hemodynamic instability during diagnostic upper endoscopy as a result of pneumomediastinum and tension pneumothorax in the absence of any signs of g astrointestinal perforation and comment on various possible mechanisms. Imm ediate endotracheal intubation and bilateral chest tube placement resulted in prompt return of the patient's oxygenation and vital signs back to norma l. This report enlarges the list of possible causes of hypoxemia during end oscopy and shows the importance of early and prompt recognition, which allo wed directed therapy with a good outcome. (Am J Gastroenterol 1999;94:845-8 47. (C) 1999 by Am. Coll. of Gastroenterology).