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Pneumoperitoneum after Endoscopic Duodenal Stent Insertion in a Patient with Percutaneous Transhepatic Biliary Drainage and Biliary Stent: A Case Report
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Jinwoo Choi, Min Ji Lee, Hyodeok Lee, Yook Kim, Joung-Ho Han, Seon Mee Park
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Clin Endosc 2019;52(3):288-292. Published online August 29, 2018
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DOI: https://doi.org/10.5946/ce.2018.128
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 Abstract
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- Early removal of a percutaneous transhepatic biliary drainage (PTBD) tube commonly causes pneumoperitoneum. However, we encountered a patient who developed pneumoperitoneum even with an indwelling PTBD tube. An 84-year-old man was admitted with type III combined duodenal and biliary obstruction secondary to metastatic bladder cancer. A biliary stent was placed using a percutaneous approach, and a duodenal stent was placed endoscopically. A large amount of subphrenic free air was detected after the procedures. Laboratory tests indicated intestinal perforation; however, peritoneal signs were absent. The patient was treated conservatively using an indwelling Levin tube. Seven days later, the massive amount of subphrenic free air disappeared. Follow-up tubography revealed unrestricted bile flow into the small intestine, and the PTBD tube was removed. Prolonged endoscopic procedures in patients with a PTBD tract communicating with the gastrointestinal tract can precipitate pneumoperitoneum. Clinicians should be careful to avoid misdiagnosing this condition as intestinal perforation.
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Citations
Citations to this article as recorded by  - The characteristics of residual pneumoperitoneum after laparoscopic colorectal surgery
Sotaro Fukuhara, Hiroyuki Egi, Masatoshi Kochi, Wataru Shimizu, Yuji Takakura, Kazuhiro Taguchi, Ikki Nakashima, Yusuke Sumi, Shintaro Akabane, Koki Sato, Hisaaki Yoshinaka, Yoshifumi Teraoka, Minoru Hattori, Hideki Ohdan
Asian Journal of Endoscopic Surgery.2022; 15(2): 320. CrossRef
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