Case Of Pneumoperitoneum Research Articles

A rare case of pneumoperitoneum caused by interstitial lung disease

Huang, Peng-Jen1; Wu, Po-Hsuan2; Hsieh, Meng-Chien Willie3; Chuang, Shih-Chang2 Author Information

A case of pneumoperitoneum due to tube dislocation after peg insertion

A case of pneumoperitoneum due to tube dislocation after peg insertion

A Rare Case of Pneumoperitoneum due to Perforation at Tip of Appendix

Pneumoperitoneum caused by a perforated appendix is extremely rare. We encountered a case of a 24 years old male presented in the emergency department of EAST surgical ward of MAYO Hospital Lahore with a history of epigastric pain for 10 days, which later became generalized. Chest X-ray showed free air under the right hemidiaphragm. On the basis of clinical examination and radiological correlations diagnosis of duodenal ulcer perforation was made. On exploration of abdomen through midline incision it was found to be a perforated appendix at its tip. The body and base of the appendix was normal. No per operative and postoperative complications were encountered and the patient discharged on the second postoperative day. Biopsy of appendix showed acute inflammation of appendix.

A rare case of Capnocytophaga canimorsus associated with pneumoperitoneum as a result of gastric ulcer perforation

• Dog bites, scratches and general exposure transmit Capnocytophaga canimorsus. • Clinicians need to screen for dog bites and scratches in unknown infections. • Capnocytophaga canimorsus rarely occurs in immunocompetent individuals. • This is the first case of pneumoperitoneum in a Capnocytophaga canimorsus infection. Capnocytophaga canimorsus infections are a rare consequence of dog or cat bites, scratches or general exposure. Their non-specific presenting features and the technical difficulties culturing the bacterium render it a challenging diagnosis. This case report describes a case of Capnocytophaga canimorsus, in an apparently immunocompetent 58-year-old male, secondary to multiple dog bites and scratches. Following antibiotic therapy, surgical repair of his perforated gastric ulcer and a post-operative stay complicated by delirium he was discharged having made a complete recovery. Literature recognises embolic secondary to Capnocytophaga canimorsus infections however, to the best knowledge of the authors, this is the only reported case of pneumoperitoneum secondary to stress ulceration in a Capnocytophaga canimorsus septicaemia. In this case the identification of multiple dog bites and scratches only occurred retrospectively after Capnocytophaga canimorsus had been cultured. This indicates that these risk factors are not routinely screened for and highlights the importance of identifying such risk when attempting to delineate the cause of sepsis of unknown origin. Whilst being the first case report of pneumoperitoneum secondary to a Capnocytophaga canimorsus infections, this case reports highlights its non-specific presenting features thus the importance of identifying animals bites and scratches when attempting to identify an infection of unknown origin.

Splenic abscess presenting as a case of pneumoperitoneum: a rare presentation

Pneumoperitoneum is more pathognomonic of ruptured hollow viscera which requires urgent surgical intervention. But uncommon surgical entities may present with pneumoperitoneum. Splenic abscess is a relatively rare medical condition that results from bacteraemia. Pneumoperitoneum in a ruptured splenic abscess is very uncommon and is often misdiagnosed as a perforation. Spontaneous rupture of splenic abscess is a life-threatening emergency mandating early surgical intervention. We report a case of ruptured splenic abscess which presented with peritonitis and pneumoperitoneum, managed successfully by splenectomy.

Pneumovesicoscopic Correction of Primary Vesicoureteral Reflux in Children: Our Initial Experience.

Purpose: The main objective of our prospective, descriptive, monocentric, longitudinal study is to demonstrate the feasibility of vesicoscopic cross-trigonal ureteral reimplantation under CO2 pneumovesicum in treatment on primary vesicoureteral reflux (VUR), analyze results, and specify the age limit of this approach. Materials and Methods: A total of 60 patients underwent transvesicoscopic ureteral reimplantation (33 boys, 27 girls) by the same surgeon from May 2011 to May 2015. All patients had primary VUR, and surgery was performed because of breakthrough urinary tract infection despite antibiotic prophylaxis and persistent high grade of VUR, especially in association with significant renal scarring, mean age at operation was 47.47 months (6 month-12 years). Of the 60 patients, 34 had bilateral reflux and 26 had unilateral reflux. The reflux grade in the total of 94 ureters was grade IV, V in 59.57%, grade III in 35.11%, and grade II in 5.32% in association with contralateral high-grade VUR. Results: The transvesicoscopic procedure was effectively completed in all patients without perioperative complication except one case of pneumoperitoneum that required exsufflation by open laparoscopy. The mean overall operative time decreased significantly with an average of 58.43 ± 11.26 minutes for unilateral reimplantation and 101.18 ± 26.5 minutes for bilateral reimplantation. The postoperative hospital stay was 3 days for all patients. The mean follow-up period was 3 years. Cystography was performed 3 months after surgery in all patients and showed the disappearance of VUR in 57/60 patients (95%) or 91/94 of ureters (97%). Persistent VUR was documented in 3 of 94 ureters and had resolved spontaneously at 12 months after reimplantation. Conclusion: Our preliminary results indicate that vesicoscopic ureteral reimplantation is safe and effective procedure with minimal morbidity when compared to traditional open method. It can be applied in children younger than 12 months.

A case of pneumoperitoneum after diagnostic colonoscopy for ulcerative colitis managed conservatively: a rare but possible complication

Ulcerative colitis is a chronic disease characterized by recurring episodes of inflammation of the colonic mucosae. Patients with ulcerative colitis are at an increased risk of perforations due to friability of colonic mucosa. Colonoscopy is usually regarded as a safe procedure, but complications may occur. Perforations associated with colonoscopy are dreaded complications. Most patients with pneumoperitoneum require surgical intervention, with associated major postoperative morbidity and mortality. This case report describes a 30 year old female presenting with an extensive pneumoperitoneum 2 days after colonoscopy done for her complaint of melena for one week. Colonoscopy was suggestive of severe active colitis in background of chronic ulcerative colitis. Histopathological reports s/o inflammatory bowel disease ulcerative colitis likely. CT Abdomen was s/o diffuse concentric thickening of the large bowel more predominantly seen in rectosigmoid colon, ascending colon, caecum, IC junction and consistent with inflammatory bowel disease and moderate pneumoperitoneum noted. The patient remained stable despite intraperitoneal free air. Patient was managed conservatively and no surgical intervention needed.

Neumoperitoneo en un paciente en tratamiento con diálisis peritoneal automática: informe de un caso

Descripción del caso: caso de neumoperitoneo en un paciente con tratamiento en diálisis peritoneal automática con día seco. Pese a que el neumoperitoneo no es una complicación grave, puede alterar la calidad de vida del paciente, por lo que es necesario investigar su origen. Tras revisar la bibliografía existente, encontramos un único caso de neumoperitoneo en terapia de diálisis peritoneal automática y se han reportado un mayor número de casos de esta complicación en pacientes con diálisis peritoneal continua ambulatoria, todos ellos debido a errores en la técnica. Tras la valoración de enfermería, el paciente identificó algunos errores en la técnica como los posibles causantes de esta complicación. Descripción del plan de cuidados: El plan de cuidados consistió en descartar otras complicaciones de la diálisis peritoneal como obstrucción de catéter o peritonitis, evaluar los posibles errores del paciente en la técnica procediendo a su reentrenamiento y ofrecer apoyo emocional al paciente y la familia. La evaluación del plan de cuidados a la semana y al mes fue favorable. Conclusiones: Como conclusión, hay que destacar la importancia de realizar un entrenamiento personalizado en cada paciente, dependiendo del tipo de terapia prescrita y las potenciales complicaciones para que el paciente las conozca y así poder prevenir su aparición.

A STORY OF EXTRAORDİNARY ABDOMİNALLY PERFORATİTON

Pneumoperitoneum is the result of a gastrointestinal (GI) tract perforation in more than 90% of cases. Perforation of the stomach or duodenum caused by peptic ulcer is considered the most common cause of pneumoperitoneum. In this article, we present a case of pneumoperitoneum associated with sigmoid colon perforation, which is the result of the patient trying to create a laxative effect by inserting the hose attached to the wash basin into his rectum and opening the water afterwards. An 89 years old male patient was brought to the emergency department with complaints of abdominal pain starting about 2 hours ago. The patient's abdominal ultrasonography showed free fluid up to 10 cm in the lower abdomen. Posterior anterior chest X-ray and direct standing abdominal X-ray of the patient had subdiaphragmatic free air and images with free fluid, pneumoperitoneum and perforation were obtained in contrast enhanced abdominal tomography. As a result of surgery performed by general surgery it was seen approximately 30 cm proximal from the rectumthat there was a 4 cm perforation in the sigmoid colon. We must consider pneumoperitoneum, which is the result of colon perforation especially in elderly patients with acute abdominal pain, to be definitely among our differential diagnoses.

Pneumoperitoneum after transoral endoscopic thyroidectomy vestibular approach.

BackgroundTransoral endoscopic thyroidectomy vestibular approach (TOETVA) is a relatively safe procedure with comparable safety profile as open thyroidectomy. While gas insufflation complications such as subcutaneous emphysema and pneumomediastinum have been reported postoperatively, there have been no reports of pneumoperitoneum.Case reportOur patient underwent an uneventful TOETVA to remove her left thyroid lobe. Postoperatively, she developed subcutaneous emphysema, pneumomediastinum, and pneumoperitoneum, which were confirmed on CT scan. She was managed conservatively and recovered uneventfully.ConclusionThe authors report the first case of pneumoperitoneum following TOETVA. Surgeons performing TOETVA should be aware of pneumoperitoneum as a possible complication of this procedure after excluding other possible causes.

Gastrointestinal Perforation Due to Gastrointestinal Stromal Tumour (GIST) In Small Intestine-A Case Report

Gastrointestinal stromal tumors (GISTs) is a mesenchymal tumor of GI tract. Now a daysdiagnosis of GISTs is more frequent then previous due to advance diagnostic tool. GISTsusually present with abdominal mass and GI bleeding but it may also present with manyunusual pattern like obstruction, perforation. Perforation of GISTs is extremely rare presentation.We report a case of pneumoperitoneum due to perforation of small intestinal GIST.Emergency laparotomy followed by resection and end to end anastomosis was done. Aftersurgical treatment lmatinibmesylate was given for prevention of early recurrence.
 Journal of Surgical Sciences (2016) Vol. 20 (2) :65-67

Chilaiditi syndrome \u2013 a rare case of pneumoperitoneum in the emergency department: a case report

BackgroundPneumoperitoneum poses an important diagnostic sign determining the urgency of management of patients in an emergency department. Chilaiditi sign is a rare radiologic finding of large intestines transposition between the diaphragm and the liver. If the patient becomes symptomatic, then the condition is called Chilaiditi syndrome.Case presentationWe present a rare case of a 49-year-old Egyptian man who presented to our emergency department complaining of cough and vague abdominal discomfort who was found to have Chilaiditi syndrome diagnosed radiologically by computed tomography scan. He was conservatively managed rather than undergoing invasive non-warranted diagnostic and therapeutic testing that may have resulted in increased morbidity.ConclusionsA review of the current literature on Chilaiditi syndrome is provided with a focus on increasing the familiarity of health care professionals with the conditions and stressing the importance of a physical examination in evaluating patients with what appears to be air under the diaphragm.

A Rare Case Of Ruptured Liver Abscess Manifested As Pneumoperitoneum- Case Report And The Review Of Literature

The presence of free air within the peritoneal cavity is known as pneumoperitoneum. In 85% to 90% of cases pneumoperitoneum is due to perforated bowel of various aetiology which includes perforated peptic ulcer, typhoid, trauma, perforated tumour etc. We are reporting is a rare case of pneumoperitoneum resulting from a ruptured liver abscess in a young male with no comorbidity. A 28 year old male presented to the casualty of RL Jalappa Hospital and Research Centre with diffuse pain abdomen. Clinically it was sus-pected as peritonitis secondary to hollow viscus perforation. Erect abdomen X-Ray showed air under dia-phragm. Exploratory laparotomy was performed. On table it was found to be a case of ruptured liver abscess for which marsupialization and thorough peritoneal lavage was given. Culture of the pus from the liver ab-scess revealed Klebsiella sensitive to Piperacillin and Tazobactam, and antibiotic treatment was adminis-tered. Conclusion: Although pneumoperitoneum resulting from a ruptured liver abscess is rare, it must be kept in mind as a possible source, especially when the hollow organs are normal. Key words: Ruptured abscess, Pneumoperitoneum, Klebsiella, Erect Abdomen X-ray

Massive Idiopathic Pneumoperitoneum in Children: A Case Report

The pneumoperitoneum is the abnormal presence of free air in the peritoneal cavity. In most cases it is related to the perforation of hollow organs. Nevertheless there are cases of pneumoperitoneum without obvious causes called idiopathic. We report a case of massive pneumoperitoneum of radiological discovery in a patient of 16 years old boy, sickle-cell of type SS, during the exploration of an angiocholitis. It was medically treated successfully. No obvious etiology had been found. This particular situation is a dogma which runs up against the classic interventionist spirit; therefore each of pneumoperitoneum needs to be studied case by case. The presence of signs of peritoneal irritation allows surgical exploration. Otherwise, laparoscopy seems to be a minimally invasive surgical method and allows a visual diagnosis by eliminating a hollow organ perforation.

Pneumoperitoneum by Inguinal Laceration after Traffic Accident

BackgroundThe leading cause of surgical pneumoperitoneum is hollow viscus perforation, which accounts for approximately 90% of cases. A nonsurgical etiology may account for up to about 10% of the causes of pneumoperitoneum. However, a pneumoperitoneum often poses significant management dilemmas for surgeons, especially when signs of peritonitis are absent or when the cause is unknown prior to laparotomy. We present the first case of pneumoperitoneum due to inguinal laceration without viscus perforation after a traffic accident. Case ReportA 17-year-old male patient was admitted to the emergency department with a deep laceration of 7∼8 cm with bleeding in the right inguinal region after a collision with a passenger car while riding a bicycle. The abdominal examination revealed diffuse abdominal tenderness on deep palpation without peritoneal signs. A chest radiograph showed no free gas below the diaphragm. On computed tomography angiography of the aorta, subcutaneous emphysema in the right inguinal and femoral areas and free air in the peritoneal cavity were observed. There was no bowel perforation in an exploratory laparotomy, but the right femoral sheath ruptured, and exposure of the femoral vessels into the peritoneal cavity was observed. Why Should an Emergency Physician Be Aware of This?A pneumoperitoneum can be caused by femoral sheath rupture without hollow viscus perforation in patients with a penetrating groin injury. Therefore, emergency physicians should not pursue solely abdominal/pelvic sources of a pneumoperitoneum in patients with a penetrating groin injury.

Pneumothorax Causing Pneumoperitoneum: Role of Surgical Intervention

The most common cause of a pneumoperitoneum is a perforation of a hollow viscus and the treatment is an exploratory laparotomy; nevertheless, not all pneumoperitoneums are due to a perforation and not all of them need surgical intervention. We hereby present a case of pneumoperitoneum due to a diaphragmatic defect, which allowed air from a pneumothorax to escape through the diaphragmatic hernia into the abdominal cavity.

Delayed Pneumoperitoneum and Acute Pulmonary Edema Secondary to Acute Gastric Dilatation.

Pneumoperitoneum caused by acute gastric dilatation (AGD) is a very rare complication. We report a case of pneumoperitoneum and acute pulmonary edema caused by AGD in a patient with Parkinson’s disease. A 78-year-old woman presented with pneumonia and AGD. We inserted a nasogastric tube and administered empirical antibiotics. We performed an endoscopy, and perforation or necrosis of the stomach and pyloric stenosis were not observed. Thirty-six hours after admission, the patient suddenly developed dyspnea and shock, and eventually died. We suspected the cause of death was pneumoperitoneum and acute pulmonary edema caused by AGD during the conservative treatment period. Immunocompromised patients with chronic illness require close observation even if they do not show any symptoms suggestive of complications. Even if the initial endoscopic or abdominal radiologic findings do not show gastric necrosis or perforation, follow-up with endoscopy is essential to recognize complications of AGD early.

An unusual case of pneumoperitoneum, pneumomediastinum, and subcutaneous emphysema following colorectal stent placement.

An unusual case of pneumoperitoneum, pneumomediastinum, and subcutaneous emphysema following colorectal stent placement.

Nonsteroidal anti-inflammatory drugs: An unusual cause of multiple ileal perforations

Introduction: In this case report, we describe a rare case of pneumoperitoneum with peritonitis due to multiple ileal perforations with a history of high doses of diclofenac sodium usage. case report: A young adult male with recent history of high doses of Nonsteroidal anti-inflammatory drugs (NsAIDs) presented in emergency department with acute onset pain in right iliac fossa with high grade fever and tachycardia for 12 hours. Abdomen was tender in the right iliac fossa with guarding. X-ray of chest showed free gas under the diaphragm. Exploratory laparotomy was done and showed multiple ileal perforations. ressection and anastomosis of the affected segment was done, both ends brought as double barrel ileostomy which was reversed later on without any complication. conclusion: High doses of Nonsteriodal anti-inflammatory drugs can cause multiple ileal erosions and perforation and should be considered in the the differential diagnosis, if other possibilities are excluded.

Double Wire-Guided Technique Improves Biliary Cannulation Rates in Difficult ERCP: 3-Year Experience

Introduction: Post-ERCP complications increase with repeated attempts at cannulation. We aimed to evaluate a number of advanced biliary cannulation techniques when standard approach fails. Methods: One thousand four hundred fifty-four consecutive patients underwent ERCP between May 2010 and July 2013 at our institution; their medical records were evaluated for demographic data, procedure indication, biliary cannulation technique used, cannulation success rate, and complications. Guidewire-assisted (GA) cannulation with no contrast injection until deep biliary cannulation was considered a standard technique. Double wire-guided (DWG) cannulation, transeptal papillary septotomy (TPS), and/or needle knife sphincterotomy (NKS) were considered advanced biliary cannulation techniques. In DWG cannulation, the bile duct is cannulated alongside a wire placed in the pancreatic duct (PD), using PD wire as a guide. In TPS-assisted biliary cannulation, a partial septotomy is performed after sphinctertome is introduced into the common channel of the papilla. Sphinctertome is then reintroduced and GA cannulation reattempted. A stepwise approach was applied: when standard technique failed, DWG cannulation was usually attempted first if PD wire was in place; if that failed, TPS or NKS was performed. Alternatively, TPS or NKS were performed alone. Results: The overall biliary cannulation success rate was 99.2% (1442/1454). Advanced techniques were used in 10% (150/1454) cases, with a 92% (138/150) success rate. Alone DWG technique was used in 69/150, TPS alone in 18/150, and NKS alone in 41/150; multiple techniques were used in 22/150. Overall DWG technique was applied in 90/150 procedures. Most common indication for ERCP requiring advanced techniques was jaundice secondary to stone disease or malignancy; average age was 50 years; 995/459 were female/male. DWG cannulation was successful in 76% (68/90). TPS was then used in 17/22 cases where DWG technique failed, and resulted in 94% (16/17) successful biliary cannulation. TPS alone was successful in 83% (15/18) cases; success rate of NKS alone was 85% (35/41). There was a trend towards increased use of TPS in the last 2 years reviewed. The overall rate of post-ERCP pancreatitis was 0.7% (6/1454), and all cases were mild. One case of pneumoperitoneum occurred after NKS and was treated conservatively. Of the 12 patients who failed advanced techniques on the first attempt, 4 were successfully cannulated with standard technique during repeat procedure. Conclusion: In our experience, the proposed stepwise approach to biliary cannulation using the double wire-guided technique is both safe and effective.