Spontan Pnömoperitoneumu Olan Olağan Dışı bir Pediatrik Vaka: Kabızlığın Neden Olduğu Pnömatozis Sistoides Intestinalis

Oktay Ulusoy,Efil Aydın,Yasin Ertuğ Çekdemir,Osman Zeki Karakuş

doi:10.5222/forbes.2021.40469

Abstract

Pneumoperitoneum almost always indicates a perforation. However, perforation is not detected approximately 5% to 15% of all exploratory laparotomies and it is called spontaneous pneumoperitoneum (SP). One of the rare causes of SP is Pneumatosis cystoides intestinalis (PCI). An 11-year-old female patient was transferred to the pediatric emergency department due to suspicion of intestinal perforation. Erect abdominal X-ray revealed pneumoperitoneum below the right diaphragm. Emergent exploratory laparotomy was performed. No perforation was detected during exploratory laparotomy. Both the absence of fever, peritoneal irritation signs and normal biochemical parameters SP must be considered. It should be kept in mind that PCI induced by constipation may be a cause of SP.

Highlights

Pneumoperitoneum almost always indicates an intestinal perforation and requires emergent surgical intervention in more than 90% of cases.[1]
Perforation is not detected in approximately 5% to 15% of all exploratory laparotomies is called spontaneous pneumoperitoneum (SP).[2]
An 11-year-old female patient was transferred to the pediatric emergency department (ED) from an external center due to suspicion of intestinal perforation

Summary

INTRODUCTION

Pneumoperitoneum almost always indicates an intestinal perforation and requires emergent surgical intervention in more than 90% of cases.[1]. Free air has been detected under the right diaphragm on erect abdominal X-ray. She had no history of acute or chronic respiratory disease, abdominal surgery, trauma or chronic medication use. Abdominal X-ray has been reported as pneumoperitoneum below the right diaphragm (Figure 1). Abdominal CT has been performed due to detecting palpable mass in physical examination. Stomach and duodenum were evaluated, there was no evidence of perforation. Both leaflets of the diaphragm were intact. The ascending, transverse and descending colon were mobilized and examined, any evidence of perforation was not detected. PCI was detected in the ascending, transverse and descending colon (Figure 3). Oral intake started on the postoperative 2nd day and the patient was discharged on the postoperative 4th day with maintenance of treatment for constipation

DISCUSSION

Findings

Du Vernoi JG