Tension pneumoperitoneum is a potentially lethal complication of many procedures, including endoscopic ultrasound guided aspiration. We report the case of a 57-year-old male with pancreatic pseudo-cysts who developed tension pneumoperitoneum and circulatory collapse after endoscopic ultrasound. Initial treatment was successful with needle decompression. Emergency surgery revealed two perforations in the stomach which were manually sutured. The patient had an uneventful recovery and was discharged home on the seventh postoperative day. Tension pneumoperitoneum is a life-threatening complication and should
be suspected in all patients who develop circulatory collapse with an acutely distended abdomen following endoscopic procedures. Treatment with needle decompression is life-saving and should not be delayed for confirmatory radiography once the clinical diagnosis is made.
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