Cause Of Pneumoperitoneum Research Articles

Ruptured Splenic Abscess with Pneumoperitoneum: A Rare Presentation

Splenic abscess is a rare entity encountered during clinical practice, with a high mortality rate. Formation of gas in splenic abscess is usually localized to the left upper quadrant of the abdomen. Here we report a case where the splenic abscess ruptured and presented with generalized peritonitis. The erect chest radiograph showed free air under the right dome of the diaphragm, thus masquerading a hollow viscera perforation (most common cause of pneumoperitoneum).

Pneumoperitoneum – Can It Be Diagnosed by Ultrasound?

Hollow organ perforation is a life-threatening condition and early diagnosis of perforation is important in improving the prognosis of these patients. The physical phenomenon that then occurs in the abdominopelvic cavum is the presence of extraluminal gas. The basic methods of detecting free gas in the peritoneal cavity are radiological: plain abdominal radiography, ultrasound and computed tomography. In the radiological literature, there is still no clear consensus which technique is optimal for the detection of pneumoperitoneum – plain abdominal radiography, ultrasound or computed tomography. CT is the gold standard for diagnosis but is often preceded by long wait times and unnecessary radiation exposure. Abdominal ultrasound can also be used as an adjunct in decision-making for justifying the risks of transporting a critically ill patient for further imaging. Based on the data presented, it can be assumed that ultrasonography should be treated as the basic method in diagnosing pneumoperitoneum. CT is the gold standard for the diagnosis of pneumoperitoneum, which can also help detect the cause of pneumoperitoneum.

Bladder perforation as unusual cause of pneumoperitoneum

Bladder perforation as unusual cause of pneumoperitoneum

Recurrent Idiopathic Spontaneous Pneumoperitoneum: A Case Report

The most common cause of pneumoperitoneum is perforated hollow viscus, which generally necessitates emergent surgical intervention. Idiopathic spontaneous pneumoperitoneum (ISP) is a rare condition less commonly described. This report outlines the case of a 79-year-old male with recurrent idiopathic spontaneous pneumoperitoneum managed by repeated laparotomy. Knowledge of this rare phenomenon and appropriate workup may allow for the avoidance of unnecessary laparotomies. Despite this, definitively ruling out perforated hollow viscus is difficult outside of the operating room, and many patients will ultimately be taken for surgical exploration and definitive diagnosis.

Perforated Meckel\u2019s diverticulum in neonates: a report of six cases and systematic review of the literature

BackgroundPerforation of Meckel Diverticulum (MD) is a rare cause of pneumoperitoneum in neonates. We hereby report six cases of perforation of MD in neonates, with addition of 53 cases from systematic review of the literature. A systematic review was performed using Mesh terms “Neonate, Meckel Diverticulum, Perforation, Pneumoperitoneum.” All reports of perforated MD in the English literature were identified. Details of our 6 cases were analyzed in similar fashion.ResultsA total of 3027 manuscripts were screened and 59 cases including 6 of our own were identified. The vast majority (78%) were female. Fifty patients (84.7%) presented in the newborn period. Half of the cases (52.5%) had associated anomalies and 13 neonates (22%) required oxygen supplementation including CPAP or ventilatory support before surgery. In 73% of the cases, a resection of gut was undertaken. Histopathological assessment in 44 cases (74.6%) revealed no ectopic gastric mucosa. Three cases demised prior to treatment. The outcome in the vast majority was excellent with 84.7% surviving and discharged well.ConclusionPerforated MD is an unusual cause of a pneumoperitoneum in the newborns. Diagnosis is established at laparotomy and it rare to find ectopic mucosa histopathologically. The overall outcome is excellent.

Pneumoperitoneum, pneumoretroperitoneum, pneumo-mediastinum, pneumothorax, and extensive subcutaneous emphysema caused by wisdom tooth extraction

Pneumoperitoneum is mainly caused by viscus perforation, in most cases by ulcer. However, it may be caused by non-surgical causes in 10 % of the cases, such as patients on respiratory support, renal dialysis, paracentesis, and anaerobic bacterial infections. In addition, there are some sporadic causes of pneumoperitoneum; one of them is wisdom tooth extraction, which is described in our case. In the literature review, there were many documented cases of subcutaneous emphysema, pneumothorax, and pneumomediastinum caused by wisdom tooth extraction. However, there was only one case that represented pneumoperitoneum after that procedure. In this case report, We are reporting a case of a 50-year-old male patient who presented one-week status post wisdom tooth extraction, with significant subcutaneous emphysema involving the face, neck, and upper chest; further workup and assessment showed that the patient has considerable pneumoperitoneum, pneumomediastinum, mild pneumothorax bilaterally, and extensive subcutaneous emphysema on computerized tomography. The patient was managed conservatively, with no need for any surgical intervention, and he was discharged home in a good general condition.

Spontaneous Pneumothorax Mimicking Perforated Viscus in Covid-19 patient

Case presentation: A 65-year-old female diagnosed with COVID-19 developed worsening respiratory distress requiring invasive ventilation. Chest radiography post-intubation revealed air under the diaphragm, pneumomediastinum and subcutaneous emphysema. The case was referred to the surgical team for emergency laparotomy for suspected perforated viscus. Clinically, her abdomen was distended but there was no sign of peritonism. In view of the high risk of perioperative morbidity and absence of peritonism, a CT scan was done to rule out the cause of pneumoperitoneum. CT scan showed bilateral pneumothorax, presence of air in the extra peritoneum and retroperitoneum. There was no air in the peritoneum and no evidence of perforated viscus. She was treated conservatively with bilateral chest tube insertion. Unfortunately, she developed multiorgan failure and succumbed to death.

Pneumoperitoneum due to pneumothorax in blunt thoracoabdominal trauma: A diagnostic challenge

Objective: A Perforation of hollow viscus is the most common cause of pneumoperitoneum after a blunt thoracoabdominal trauma and demands prompt surgical exploration. Alternative routes into the peritoneal cavity, such as the presence of a diaphragmatic laceration associated with pneumothorax, although rare, should be considered when approaching these patients. Case Presentation: We present the case of a 78-year-old male admitted to the emergency department after being ran over by a car resulting in right thoracoabdominal trauma, presenting with dyspnea and signs of peritoneal irritation. CT scan identified right pneumothorax, pneumoperitoneum and free abdominal fluid. The pneumothorax was drained and posteriorly he underwent exploratory laparotomy where a traumatic laceration of the diaphragm was identified as the cause of pneumoperitoneum. Conclusion: Alternative causes of pneumoperitoneum should be considered in blunt thoracoabdominal trauma with possibility of conservative management in the absence of peritoneal irritation signs. Pneumothorax drainage is mandatory before intubation to avoid creation of a tension pneumothorax.

Perforated Meckel's diverticulum as a cause of pneumoperitoneum in a VLBW new-born

We report the case of a preterm weighting 755g who showed a massive pneumoperitoneum 14 hours after birth without clinical signs of an Necrotizing enterocolitis (NEC). In surgery, a round hole with everted edges was found in the middle course of the small bowel without surrounding ischemic necrosis or significant peritonitis. The child was successfully treated with resection and anastomosis, with uneventful short-term postoperative recovery. Both macroscopic and microscopic features were consistent with a perforation of the Meckel remnant. The theoretical etiopathogenesis of this uncommon pathology and the predisposing factors in the preterm population are discussed as well as the treatment. The few cases reported in literature, including the present case, which is the smallest one described to date, encourage consideration of a perforated Meckel's diverticulum as one of the possible causes of free peritoneal air in preterm new-borns, separate from the consequences of an NEC.

Benigní asymptomatické pneumoperitoneum u pacientky po CT kolografi i

Pneumoperitoneum is a condition that refers to the presence of free air (gas) in the abdominal cavity. Differential diagnosis of the causes of pneumoperitoneum varies widely and represents varying degrees of severity. In the patients who have not recently underwent laparotomy or laparoscopy, the finding of pneumoperitoneum is usually a sign of gastrointestinal perforation that requires immediate surgical approach due to the risk of peritonitis with subsequent life-threatening sepsis. However, not all causes of pneumoperitoneum require surgery. In our case report, we present a rare case of clinically asymptomatic pneumoperitoneum that developed in a 66-year-old patient after CT colonography. In this diagnostic method, we inflate colon with carbon dioxide (CO2 ); therefore this kind of pneumoperitoneum can de facto be called capnoperitoneum. In this patient, free air (gas) in the abdominal cavity manifested itself in the so-called benign pneumoperitoneum, which is defined as asymptomatic free air in the abdominal cavity and pneumoperitoneum without peritonitis. Despite the fact that CT colonography is considered a method with a very low incidence of complications, it is necessary to take into account the presence of risk factors in its indication and to contraindicate to avoid the number of postoperative complications. The fundamental message of our case report is that extensive pneumoperitoneum after proven CT colonography can be asymptomatic and can be treated conservatively (if clinical and laboratory results are favorable).

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.

Pneumothorax and pneumoperitoneum caused by penetrating chest injury

Pneumothorax and pneumoperitoneum caused by penetrating chest injury are rare. Pneumoperitoneum following trauma usually indicates the presence of a perforated intraabdominal hollow viscous. Other causes of pneumoperitoneum are through the abdominal wall, through the diaphragm, through female genital tract and through retroperitoneum. Here we report an unusual case of pneumothorax and pneumoperitoneum caused by penetrating injury in the posterior aspect of chest in a young male patient of 33 years who presented to us with chest & abdominal pain & breathlessness. The diagnosis was made on clinical & radiological examination. Tube thoracostomy was done followed by laparotomy and repair of diaphragmatic & splenic injury. Post operative recovery was uneventful & the patient was discharged on 9th p.o.d after removal of thoracostomy tube & wound stiches.
 Journal of Surgical Sciences (2018) Vol. 22 (1) : 67-69

Neumatosis quistica intestinal, como causa infrecuente de neumoperitoneo

Introducción: La neumatosis quística intestinal se caracteriza por la presencia de múltiples quistes llenos de gas localizado en la submucosa o subserosa de la pared intestinal, esta patología predomina en el sexo masculino y su localización más frecuente es el colon. Con respecto a su etiología es poco conocida y posiblemente multifactorial, siendo idiopática en el 15% de todos los casos o secundaria a una amplia variedad de enfermedades en el 85%. Las complicaciones ocurren en el 3% de los casos, incluyendo neumoperitoneo puede ocurrir debido a la ruptura de quistes subserosos, cuyo tratamiento es conservador en la mayoría de los casos.
 Objetivo: Describir un caso clínico enfocado en neumatosis intestinal como causa infrecuente de neumoperitoneo.
 Material y métodos: Estudio descriptivo retrospectivo, presentación de caso clínico en el Hospital Básico “IESS Latacunga”, caso que fue tratado en el Servicio de Cirugía General del hospital. Se presenta el caso de un paciente de sexo femenino de 67 años de edad, con antecedentes personales de enfermedad pulmonar obstructiva crónica sin tratamiento, acude por dolor abdominal en hipocondrio derecho, de varios años de evolución, que se exacerba en las últimas 24 horas de leve intensidad. En la exploración física se observó un abdomen distendido, doloroso a la palpación en hipocondrio derecho, Murphy positivo, sin signos de peritonismo. En la radiografía estándar de tórax se observó neumoperitoneo, en la ecografía de abdomen superior se encontró múltiples cálculos en vesícula biliar. Ante estos hallazgos se decidió practicar una colecistectomía convencional en la que se identificó incidentalmente una neumatosis quística intestinal. La evolución de la paciente fue favorable.
 Resultados: Luego de la valoración del paciente, se determinó una impresión diagnostica y su resolución quirúrgica, logrando evitar posteriores complicaciones. Como impresión diagnostica inicial se sospechó colelitiasis y neumoperitoneo en estudio. La causa de neumoperitoneo se determinó durante el procedimiento quirúrgico, hallando una neumatosis quística intestinal.
 Conclusiones: La neumatosis quística intestinal es un signo radiológico o endoscópico, caracterizado por la presencia de gas en la pared intestinal, de etiología muy variable. La ruptura de dichos quistes, en pocas condiciones causa neumoperitoneo, generalmente asintomático con tratamiento conservador.

Massive pneumopritoneum with no evidence of hollow viscus perforation, a possible hepatobiliary source; a case report

Presenter: kiarash Mashayekhi MD,MS | San Joaquin General Hospital Background: Pneumoperitoneum is most frequently caused by hollow viscous perforation, which in most cases requires an exploratory laparotomy. In the event where no perforation can be identified, one must consider other rare causes of pneumoperitoneum. Methods: We report a case of a woman who presented to the emergency department with severe abdominal pain and nausea. Results: On initial exam the patient had peritonitis, and the CT of her abdomen & pelvis showed a substantial pneumoperitoneum, with a dilated cecum and ascending colon, and gallstones within a distended gallbladder. Initial exploratory laparotomy showed no hollow viscus perforation, an unroofed left liver lobe abscess, and a distended gallbladder. Further imaging after the initial operation showed significant choledocholithiasis, although her hepatic function tests remained normal. Subsequently the patient underwent ERCP, sphincterotomy, multiple stone extraction and stent placement. Two further exploratory laparotomies were performed for cholecystectomy and drainage of liver abscess, again with no identifiable hollow viscus perforation. Cultures drawn from the peritoneal fluid and abscess grew gas-forming organisms, prominently Klebsiella Pneumoniae. Over the next few weeks the patient decompensated and developed septic shock, and multi organ failure in spite of maximal therapy; she ultimately died from septic shock due to overwhelming hepatic and intraperitoneal abscesses. Conclusion: This case highlights a very uncommon etiology for pneumoperitoneum in the absence of hollow viscus perforation, from the hepatobiliary tract, associated with ascending cholangitis from an invasive form of Klebsiella Pneumoniae liver abscess syndrome.

1619 Not All Intra-Peritoneal Free Air Is Created Equal. Pneumatosis Cystoides Intestinalis Causing Massive Pneumoperitoneum After a Colonoscopy, a Benign Finding

INTRODUCTION: Pneumoperitoneum is the presence of free air in the peritoneal cavity. Visceral perforation, obstruction, and infection are the most ominous causes and usually present with signs of acute peritonitis requiring emergent surgery. CASE DESCRIPTION/METHODS: A 60-year-old man was found to have extensive colonic wall bullae (pneumatosis coli) in the transverse colon during a colonoscopy (Figure 1). Contrast-enhanced abdominal computed tomography (CT) 6 days later detected free air in the peritoneal cavity, the umbilical subcutaneous fat, and pneumatosis intestinalis in the distal transverse colon (Figure 2). Patient reported mild abdominal distension which quickly improved, otherwise he was asymptomatic. His abdomen was distended, but benign with no signs of peritoneal irritation. His laboratory work was unremarkable with normal white blood cell count and lactic acid. He was managed conservatively with nothing by mouth, intravenous fluids and systemic antibiotic therapy. He completed a 10-day course of antibiotics at home. A CT abdomen 2 months later showed complete resolution of the pneumoperitoneum (Figure 3). DISCUSSION: Prompt diagnosis of pneumoperitoneum and its cause is crucial, and it may require timely surgical intervention. However, there are causes of pneumoperitoneum that do not require surgery; these cases must be readily distinguished. One of the etiologies of asymptomatic pneumoperitoneum is rupture of the sub-serosal cysts present in the colonic wall of patients with idiopathic pneumatosis cystoides intestinalis. Primary pneumatosis intestinalis (15% of cases) is a benign idiopathic condition in which thin-walled cysts develop in the submucosa or subserosa of the colon. The secondary form (85% of cases) is associated with obstructive pulmonary disease, as well as with obstructive and necrotic gastrointestinal disease, infection, inflammatory bowel disease, medication-induced (chemotherapy and steroid), autoimmune disease, immunosuppression, and connective tissue disorders. In conclusion, intraperitoneal air is not always related to life-threatening conditions e.g. visceral perforation requiring invasive interventions; sometimes it is related to benign causes, one of them which we mentioned in our case. Therefore, the correlation should be made with the clinical presentation, frequent abdominal exams, imaging findings, and laboratory tests to prevent unnecessary interventions.

AB184. 144. Perforated jejunal diverticulum as an unusual cause of pneumoperitoneum

AB184. 144. Perforated jejunal diverticulum as an unusual cause of pneumoperitoneum

An unusual cause of pneumoperitoneum—Traumatic vaginal dehiscence six months after hysterectomy

Introduction: Intraperitoneal free air usually results of the perforation of a hollow viscus. A high degree of suspicion based on previous medical history can identify a gynecologic origin.

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.

İdiopatic spontan pnömoperitoneumun sıklığı: 2.36%

Objective: Pneumoperitoneum often occurs following a visceral perforation, often seen with peritonitis, and requires urgent surgical intervention. Non-surgical spontaneous pneumoperitoneum (not associated with organ perforation) is a rare condition caused by intrathoracic, intraabdominal, gynecologic, iatrogenic, and other causes, and may be treated conservatively. Spontaneous idiopathic pneumoperitoneum is not caused by visceral perforation, the cause may be extra-abdominal origin and sometimes cannot be determined. Material and Method: This study is a retrospective review of 338 patients who were examined in our clinic because of abdominal pain or if intraabdominal free air was determined in imaging. Patients whose cause of pneumoperitoneum was of surgical etiology were excluded from the study. Patients with abdominal pain were divided into two groups according to the absence or presence of acute abdomen findings. Patients without acute abdomen findings were kept under observation for a minimum of 48-72 hours. Diagnostic laparoscopy was performed in patients with acute abdomen findings, according to leukocyte and C-reactive protein (CRP) values. The patients were managed with a specific protocol if any pathologic etiology was detected in the step-by-step laparoscopic or laparotomic exploration. Results: Of the 338 patients, 8 were diagnosed as having idiopathic spontaneous pneumoperitoneum (2.36%). Four patients were diagnosed as having non-surgical spontaneous pneumoperitoneum (1.18%), and 4 patients had surgical pneumoperitoneum (1.18%). Conclusion: Surgery was unavoidable in patients with spontaneous pneumoperitoneum and acute abdomen findings. Even though no inflammatory process has been determined, surgical exploration should be performed in a step-by-step protocol.

Frequent postoperative gas expansion of the abdominal drain bag for a case of idiopathic neonatal pneumoperitoneum: A case report

Abstract Introduction There have been non-surgical conditions secondary to neonatal pneumoperitoneum (e.g., mechanical ventilation, pulmonary diseases and pneumatosis cystoides intestinalis) that neonates were able to overcome without the need for abdominal exploration. Idiopathic pneumoperitoneum, although similar to perforation of the alimentary tract and the previously mentioned non-surgical conditions, is a rare and benign condition that does not yet have a definite cause. The criteria by which a surgeon decides on which abdomen to open and which one to observe, is ill-defined. Thus, increasing the awareness of neonatologists and surgeons about this condition will help decrease complications due to unnecessary procedures. Presentation of the case We report a case of a neonate with a massive pneumoperitoneum who obtained a surgical intervention. We had noted that the bag of the abdominal drain was expanded with gas every 2 days, we replace the bag by new one every 2 days for 10 days postoperative. Nonetheless, the cause of pneumoperitoneum remains unclear. Discussion There are five main nonsurgical causes of free air in the peritoneal cavity. These are categorized as follow: pseudopneumoperitoneum, thoracic, abdominal, gynecological and idiopathic. This is a condition in which imaging shows free air in the peritoneal cavity that can either be managed with observation and supportive care alone or results in a negative laparotomy. Conclusion This case demonstrated that laparotomy is not a true routine in neonates with idiopathic pneumoperitoneum if a timely diagnosis is established. Future research is still necessary to understand the source of the free gas in the abdomen, as well as the underlying causes of delayed postoperative gas underdiaphragm and postoperative abdominal drain bag gas expansion.