RESUMEN
INTRODUCTION AND IMPORTANCE: Pneumoperitoneum is a well-known consequence of gastrointestinal perforations but can also be a consequence of medical diseases such as asthma exacerbations or interventions such as mechanical ventilation. Tension pneumoperitoneum is a rare, life-threatening form of large volume pneumoperitoneum that can cause cardiovascular and respiratory compromise due to increased intra-abdominal pressure. CASE PRESENTATION: We present a case report where an 86-year-old male was diagnosed with large volume pneumoperitoneum with compression of the inferior vena cava and intra-abdominal hollow and solid organs due to a suspected splenic flexure perforation in the setting of an acute colonic pseudo-obstruction that was able to be successfully managed solely with bedside needle decompression. CLINICAL DISCUSSION: Large volume pneumoperitoneum and tension physiology requires early diagnosis and prompt intervention. Patients are often critically ill and require major abdominal surgery if secondary to gastrointestinal perforation. CONCLUSION: Select patients and clinical presentations of tension pneumoperitoneum can be managed successfully with bedside needle decompression if diagnosis and intervention is prompt.