Abstract
Idiopathic spontaneous pneumoperitoneum is a rare condition that is characterized by intraperitoneal gas for which no clear etiology has been identified. We report here a case of idiopathic spontaneous pneumoperitoneum, which was successfully managed by conservative treatment. A 77-year-old woman who was bedridden with speech disability as a sequela of brain hemorrhage presented at our hospital with a 1-day history of abdominal distention. On physical examination, she had stable vital signs and slight epigastric tenderness on deep palpation without any other signs of peritonitis. A chest radiograph and computed tomography showed that a large amount of free gas extended into the upper abdominal cavity. Esophagogastroduodenoscopy revealed no perforation of the upper gastrointestinal tract. The patient was diagnosed with idiopathic spontaneous pneumoperitoneum, and conservative treatment was selected. The abdominal distension rapidly disappeared, and the patient resumed oral intake on the 5th hospital day without deterioration of symptoms. Knowledge of this rare disease and accurate diagnosis with findings of clinical imaging might contribute towards refraining from unnecessary laparotomy.
Highlights
Radiographic manifestation of free gas in the peritoneal cavity often suggests intra-abdominal emergencies, including gastrointestinal tract perforation, in which timely surgical intervention is required
Idiopathic spontaneous pneumoperitoneum (ISP) is a rare condition that is characterized by intraperitoneal gas without gastrointestinal tract perforation, for which no clear etiology has been identified [1]
We present a case of ISP that appeared in a bedridden patient with cerebral hemorrhage sequela
Summary
Radiographic manifestation of free gas in the peritoneal cavity often suggests intra-abdominal emergencies, including gastrointestinal tract perforation, in which timely surgical intervention is required. We present a case of ISP that appeared in a bedridden patient with cerebral hemorrhage sequela. The patient was bedridden with speech disability as a sequela of brain hemorrhage She was cared for in a nursing facility and had no other comorbidities on treatment or a history of laparotomy. The results of laboratory tests were as follows: the white blood cell count was 8120/mm, hemoglobin was 14.6 g/dl, the serum C-reactive protein level was 0.05 mg/dl, PaCO2 was 39.6 mmHg, PaO2 was 80.8 mmHg, and base excess was 0.8 mmol/l Based on these findings, we diagnosed the patient with ISP.
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