Unusual cause of obstructive shock following esophagectomy: a case report

Abstract

Obstructive shock usually has an intrathoracic origin, such as pneumothorax, pericardial tamponade or pulmonary embolism. We report a case of hemo- dynamic shock in a 74-year-old patient four days after esophagectomy, just after the start of mechanical ventilation for bilateral pneumonia. The sudden onset of severe abdominal distension and the presence of air in the intra-abdominal drain suggested tension pneumoperitoneum, confirmed by radiography. No pneumothorax was associated. Urgent decompression was required to improve hemodynamics. Perforation of the gastrointestinal tract was ruled out. The cause was a bronchopleural fistula opened by mechanical ventilation. Rarely, cardiorespiratory failure may occur after tension pneumoperitoneum by reducing lung volume and cardiac preload, similar to obstructive shock from the usual intrathoracic causes or acting as an abdominal compartment syndrome (ACS). Its recognition and abdominal decompression are key steps in the patient’s recovery. Tension pneumoperitoneum related to mechanical ventilation and airway injury without associated pneumothorax is exceptional and, to our knowledge, has never been reported as a postoperative complication of esophagectomy.