PMC6360270_01
Endoscopic ultrasound showing a 32 mm adenocarcinoma (dots). The ulcerated tumor does not invade the muscularis.
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Endoscopic ultrasonography showed a hypoechoic, 3.2 cm neoplasm, without muscularis externa infiltration and reactive ganglia (Fig. 1).
Distended abdomen at the end of the endoscopic procedure.
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At the end of the procedure the anesthesiologist had difficulty with ventilation and abdominal distention was observed (Fig. 2).
Abdominal radiography showing sub-diaphragmatic free air (white arrows), Rigler s sign (white triangles), air in both sides of the intestine wall; and Falciform ligament sign (black arrow).
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A plain abdominal radiography in the operating room showed a massive pneumoperitoneum (Fig. 3).
Abdominal CT-scan. a. Sagittal view showing the presence of air in the peritoneal cavity with posterior displacement of the intra-abdominal contents b. Axial view, showing the Falciform ligament sign (white arrow). c. Axial view showing percutaneous decompression with a multipurpose drainage catheter (white arrow) in the periumbilical position. d. Axial view after percutaneous decompression.
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A CT scan confirmed the massive pneumoperitoneum without intraperitoneal extravasation of contrast (Fig. 4a & b). A percutaneous decompression guided by CT scan was performed with a pigtail catheter G14 (Fig. 4c & d).