Pneumopericardium and multicompartmental air dissemination after colorectal endoscopic resection managed conservatively: a case report.

Background: Colonoscopy-associated perforation is a recognized complication of therapeutic lower gastrointestinal endoscopy. However, extensive extraintestinal air dissemination, particularly pneumopericardium, is rare and may raise concern for potentially life-threatening cardiopulmonary complications. Optimal management remains controversial, especially in clinically stable patients. Case presentation: We report a 37-year-old man with no known cardiopulmonary comorbidities who developed abdominal distension and chest tightness shortly after endoscopic resection of a descending colon lesion at a regional referral centre. The lesion measured approximately 1.0 × 1.2 cm and was treated with snare-based endoscopic resection after submucosal injection, followed by clip closure. On admission, examination revealed abdominal distension and subcutaneous crepitus. Laboratory testing showed leukocytosis, while computed tomography demonstrated pneumoperitoneum, pneumomediastinum, pneumopericardium, and subcutaneous emphysema. The patient remained hemodynamically stable without features of cardiac tamponade. Colonoscopic perforation with extensive air dissemination was diagnosed. In the absence of peritonitis or circulatory compromise, conservative management was initiated, including bowel rest, gastrointestinal decompression, high-flow oxygen, and antibiotics. The patient improved, with follow-up imaging showing marked resolution, and was discharged without complications. Conclusion: This case suggests that even extensive extraintestinal air, including pneumopericardium, can be managed conservatively in carefully selected patients who remain hemodynamically stable and without peritonitis. Clinical condition should be considered more important than imaging findings when making management decisions.