Spontaneous combustile pneumoperitoneum

Abstract

Fire and explosions in the operation theatre during surgery in the era of cautery usage have been reported since many years. Significant complications or death can ensue as a result of such fires or explosions and surgeons should be aware of these hazards. A 38 year old female patient on the 6th day of admission, developed abdominal distension. Patient was managed conservatively with flatus tube insertion and serial x-ray monitoring. On the 8th day, repeat x-ray showed gas under diaphragm. Emergency laparotomy was undertaken. On opening the peritoneum using cautery, a hissing escape of gas was heard and this caught fire. On attempting to stem gas flow from the peritoneal hole, the operating surgeon sustained burn to his index finger and the glove melted. The peritoneal cavity was surprisingly free of any spilled contents. Small bowel was opened through a small enterotomy and decompressed. The colon steadfastly refused to collapse. This necessitated a transverse colotomy which, after decompression, was converted into a loop transverse colostomy. She underwent colonoscopy after three weeks wherein the colon was found to be free of any obstruction. The colostomy was closed. If there is free gas on entering a peritoneum, it will be wiser to avoid electro surgery. Instead, scissors or a scalpel should be used.