Case report Life threatening tension pneumoperitoneum from intestinal perforation during air reduction of intussusception E. NG MD, FRCPC MD, FRCPC *, H.B. KIM MD MD †, C.W. LILLEHEI MD MD † AND C. SEEFELDER MD MD * Departments of *Anesthesia and †Surgery, Children’s Hospital, Boston, MA, USA Summary We present a case report of a child with intussusception who underwent air reduction which was complicated by bowel perfor- ation. Life threatening tension pneumoperitoneum developed rapidly and immediate needle decompression was life saving in this case. The pathophysiology of hyperacute abdominal compartment syndrome is discussed. Keywords: intussusception; perforation; abdominal compartment syndrome; infant Introduction Intussusception is the most common cause of intes- tinal obstruction in children aged between 3 months and 6 years of age. A portion of the bowel is telescoped into a segment just distal to it. Venous return from that portion of the bowel is constricted, with associated oedema and bleeding from the mucosa. Clinically, patients may present with severe paroxysmal colicky abdominal pain. In more advanced stages, this may be associated with vom- iting, lethargy and fever. Passage of Ôcurrant jelly stoolÕ may be present. The diagnosis is confirmed by plain X-ray, ultrasound and ⁄ or barium or pneumatic contrast studies. Treatment of choice in stable patients is by hydrostatic or pneumatic reduction under fluoroscopic guidance. Patients are taken to the operating room if they present with shock, peritonitis or intestinal perforation, or if they fail therapeutic reduction. A rare complication of pneu- matic reduction of intussusception is tension pneu- moperitoneum, which is well described in the radiology texts (1), but not in the paediatric anaes- thesia literature. We present a case report of a child who suffered life threatening abdominal compart- ment syndrome from acute tension pneumoperito- neum related to air reduction of intussusception. Case report A previously healthy 9-month-old child, weighing 10 kg, was brought to the emergency department with a 2-day history of abdominal pain, vomiting and Ôcurrant jelly stoolÕ. He was diagnosed with intussusception and air enema was attempted. This was performed in the radiology department with- out sedation and without electronic monitoring in attendance of a nurse, the radiologist and a senior surgical resident. During the procedure, reduction of intussusception was unsuccessful but free intraperi- toneal air was noted. Although insufflation pressure had been limited to less than 90 mmHg and insuf- flation was stopped immediately, the child’s abdo- men became extremely distended and tense and the child became tachypnoeic. He was taken to the Correspondence to: E. Ng, Department of Anesthesia, Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA (e-mail: eky.ng@utoronto.ca). Paediatric Anaesthesia 2002 12: 798–800 798 Ó 2002 Blackwell Science Ltd