Safety Concerns with Thoracoabdominal Acupuncture: Experience at a Tertiary-Care Emergency Department

Objective. To evaluate serious complications caused by acupuncture treatment and to increase awareness of this complication. Design. A retrospective observational study. Setting. At the emergency department of a tertiary hospital in an urban area during a five-year period (2010-2014) in Seoul, Korea. Subjects. Patients with postacupuncture mechanical complications in the thoracoabdominal region. Methods. All cases were independently assessed for inclusion by two emergency physicians based on the causal relationship between acupuncture and emergency department presentation. Results. There were 10 cases of pneumothorax (one combined with pneumomediastinum) and two cases of pneumoperitoneum induced by acupuncture. Five of the 12 patients were male; the mean age was 43.4 years. The mean time between acupuncture and emergency department admission was 1.6 days. The pneumothorax was unilateral in eight cases and bilateral in two. Eight patients underwent tube thoracostomy (pig tail catheter or chest tube insertion) and were admitted to the hospital for a median of 11 days. Of the two patients with pneumoperitoneum, one was transferred to another hospital for emergency surgery and the other was admitted to our hospital after emergency total colectomy. Conclusions. Life-threating complications such as pneumothorax and bowel perforation after acupuncture can occur, and this suggests that physicians, especially acupuncturists, should be aware of the risk associated with needling around the trunk region. To maximize the safety of acupuncture, adequate competency-based training should be provided.