case_images: PMC6360270_01
case_images: Endoscopic ultrasound showing a 32 mm adenocarcinoma (dots). The ulcerated tumor does not invade the muscularis.
case_images: gr1.jpg
case_images: PMC6360270_01_gr1.jpg
case_images: fig0005
case_images: Endoscopic ultrasonography showed a hypoechoic, 3.2 cm neoplasm, without muscularis externa infiltration and reactive ganglia (Fig. 1).
case_images: Distended abdomen at the end of the endoscopic procedure.
case_images: gr2.jpg
case_images: PMC6360270_01_gr2.jpg
case_images: fig0010
case_images: At the end of the procedure the anesthesiologist had difficulty with ventilation and abdominal distention was observed (Fig. 2).
case_images: 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).
case_images: gr3.jpg
case_images: PMC6360270_01_gr3.jpg
case_images: fig0015
case_images: A plain abdominal radiography in the operating room showed a massive pneumoperitoneum (Fig. 3).
case_images: 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.
case_images: gr4.jpg
case_images: PMC6360270_01_gr4.jpg
case_images: fig0020
case_images: 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).