Bilateral tension pneumothorax after TEM: a rare complication

Excerpt

We report of a patient who underwent a transanal endoscopic microsurgery (TEM) of a presumed benign adenoma of the rectum. The patient had a previous history of hypertension, and a percutaneous transluminal coronary angioplasty had been performed. The patient presented to the hospital with a history of rectal blood loss. On examination, there was a palpable tumour at 3 cm of the anal canal. Pathological examination revealed an adenoma. The patient was operated in left decubital position. During the removal of the tumour, there was a perforation of the rectum; this was recognized, and an attempt was made to close the defect by a running suture. However, at this stage, the gas source broke down, and we were unable to retain pressure at the desired level; therefore, this was done with the hand-pump. Now the defect in the rectum could easily be closed. At the end of the operation, the patient suffered from a reduced oxygen level, and high pressures were needed for ventilation (this could only be done by hand). Subsequently, the patient was returned in normal supine position. There was a marked increase in abdominal size. It was presumed that air was blown into the abdominal cavity and was responsible for this increase and subsequent iatrogenic abdominal compartment syndrome. A verres needle was inserted for air to escape the abdominal cavity. …