{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T02:28:04Z","timestamp":1777861684429,"version":"3.51.4"},"reference-count":14,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":118,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"publisher","award":["25K19310"],"award-info":[{"award-number":["25K19310"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012043","name":"Kindai University","doi-asserted-by":"publisher","award":["IP007"],"award-info":[{"award-number":["IP007"]}],"id":[{"id":"10.13039\/100012043","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Gastrointestinal Medicine"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>\n                    Endoscopic ultrasonography (EUS)\u2013guided drainage followed by direct endoscopic necrosectomy (DEN) is widely used as a minimally invasive treatment for walled\u2010off necrosis (WON). While this approach is considered effective and safe, serious complications may occur. We report a case of carbon dioxide (CO\n                    <jats:sub>2<\/jats:sub>\n                    )\u2013related tension pneumoperitoneum accompanied by severe hypercapnia during DEN. A 65\u2010year\u2010old man with gallstone pancreatitis developed a large WON causing gastric outlet obstruction. He underwent EUS\u2010guided transgastric drainage with placement of a lumen\u2010apposing metal stent (LAMS), followed by planned DEN sessions under CO\n                    <jats:sub>2<\/jats:sub>\n                    insufflation with propofol sedation. During the second DEN session, the LAMS became dislodged, and subsequent DEN was continued after balloon dilation of the endosonographically created route. During the fourth DEN session, the patient experienced sudden oxygen desaturation. Imaging revealed extensive free air in the abdominal and thoracic cavities, and arterial blood gas analysis showed severe hypercapnia. Emergency exploratory laparotomy revealed disruption of the WON wall with communication into the abdominal cavity. Surgical necrosectomy and abdominal irrigation were performed. The patient recovered uneventfully. This case highlights a rare but potentially serious CO\n                    <jats:sub>2<\/jats:sub>\n                    \u2010related complication of DEN and underscores the need for meticulous control of intracavitary pressure and close respiratory monitoring during the procedure.\n                  <\/jats:p>","DOI":"10.1155\/crgm\/6599334","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T04:50:21Z","timestamp":1777524621000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Rare but Life\u2010Threatening Complication of Direct Endoscopic Necrosectomy: Tension Pneumoperitoneum With Pneumothorax and Hypercapnia due to Walled\u2010Off Necrosis Rupture"],"prefix":"10.1155","volume":"2026","author":[{"given":"Yasuo","family":"Otsuka","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5407-7925","authenticated-orcid":false,"given":"Kosuke","family":"Minaga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akane","family":"Hara","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mamoru","family":"Takenaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chihoko","family":"Nobori","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takaaki","family":"Murase","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3965-3693","authenticated-orcid":false,"given":"Ippei","family":"Matsumoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4102-3474","authenticated-orcid":false,"given":"Masatoshi","family":"Kudo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"key":"e_1_2_12_1_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.20317"},{"key":"e_1_2_12_2_2","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2019.07.064"},{"key":"e_1_2_12_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.1146"},{"key":"e_1_2_12_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-009-1100-7"},{"key":"e_1_2_12_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2014.02.015"},{"key":"e_1_2_12_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa0908821"},{"key":"e_1_2_12_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.276"},{"key":"e_1_2_12_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12328-017-0763-y"},{"key":"e_1_2_12_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.13398"},{"key":"e_1_2_12_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2017.06.029"},{"key":"e_1_2_12_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-011-1908-6"},{"key":"e_1_2_12_12_2","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1002\/jhbp.12110","article-title":"Capnographic Monitoring Using a Novel Mainstream System During Endoscopic Ultrasound and Endoscopic Retrograde Cholangiopancreatography: A Prospective Randomized Controlled Trial","volume":"32","author":"TakimotoY I. E.","year":"2025","journal-title":"Journal of Hepato-Biliary-Pancreatic Sciences"},{"key":"e_1_2_12_13_2","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2023-330396"},{"key":"e_1_2_12_14_2","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1392506"}],"container-title":["Case Reports in Gastrointestinal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/crgm\/6599334","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1155\/crgm\/6599334","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1155\/crgm\/6599334","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T04:50:40Z","timestamp":1777524640000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1155\/crgm\/6599334"}},"subtitle":[],"editor":[{"given":"Neetu","family":"Rawal","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":14,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1155\/crgm\/6599334"],"URL":"https:\/\/doi.org\/10.1155\/crgm\/6599334","archive":["Portico"],"relation":{},"ISSN":["2090-6528","2090-6536"],"issn-type":[{"value":"2090-6528","type":"print"},{"value":"2090-6536","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2026-02-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"6599334"}}