How to distinguish between surgical and non-surgical pneumoperitoneum?

Filip Čečka ,O Sotona ,Z Šubrt

doi:10.22514/sv91.042014.1

Filip Čečka , O Sotona + Show 1 more

Open Access

https://doi.org/10.22514/sv91.042014.1

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Abstract

Not all cases of pneumoperitoneum found on abdominal X-ray or computed tomography (CT) scan are caused by hollow viscus perforation. Non-surgical or spontaneous pneumoperitoneum is a repeatedly described entity. However, not all physicians in emergency departments are aware of it, and in such cases unnecessary laparotomy is often performed which reveals no intra-abdominal pathology. Non-surgical pneumoperitoneum can have thoracic, abdominal, gynecological, or other causes. When we acknowledge the possibility of non-surgical pneumoperitoneum, the primary goal is to discern surgical from non-surgical pneumoperitoneum. Identifying cases in which laparotomy can be avoided is important to prevent unnecessary surgery and its associated morbidity and financial costs. In this paper we propose a practical algorithm which may help the attending physicians to distinguish between surgical and non-surgical pneumoperitoneum.

Highlights

Patients with acute abdomen are commonly encountered in departments of emergency medicine around the world
Not all cases of pneumoperitoneum found on abdominal X-ray or computed tomography (CT) scan are caused by hollow viscus perforation
When we acknowledge the possibility of non-surgical pneumoperitoneum, the primary goal is to discern surgical from non-surgical pneumoperitoneum

Summary

Introduction

Patients with acute abdomen are commonly encountered in departments of emergency medicine around the world. The examination process of these patients includes a plain abdominal X-ray in the majority of cases, as it is an easy, low-cost, non-invasive and efficient method of searching for intraabdominal pathology, mainly pneumoperitoneum. Emergency physicians are often the first to recognize pneumoperitoneum in the patient They should be aware of the possible causes of non-surgical pneumoperitoneum and should play the decisive role in preventing needless laparotomy in these patients. The term pneumoperitoneum is used to describe an abnormal collection of air within the peritoneal cavity. Pneumoperitoneum is visible on abdominal X-ray in 85% of cases with a rupture of a hollow organ. In case of suspicion for perforation and no pneumoperitoneum being visible on abdominal X-ray, a computed tomography (CT) scan should be more helpful. The main goal of this study is to propose a decision-making algorithm that can help to distinguish between surgical and nonsurgical cases of pneumoperitoneum

Definition and aetiology

Findings

Conclusion