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Johnson EK, Choi YU, Jarrard SW, Rivera D. Pneumoperitoneum after rough sexual intercourse. Am Surg 2002; 68:430-3. [PMID: 12013285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Our objective is to report on a case of nonsurgical pneumoperitoneum and review the mechanism/gynecologic causes of such. We present a case report and review of the literature based on a MEDLINE search using the keywords pneumoperitoneum and nonsurgical. Radiographic evidence of free intraperitoneal air suggests hollow viscus rupture and usually warrants urgent surgical management. Findings of diffuse rebound tenderness and guarding solidify the decision for urgent surgical exploration. We present a case of a patient who presented with all of the above findings that subsequently underwent a negative laparotomy. On the day after surgery she admitted to having had rough sexual intercourse 3 days before presentation. Nonsurgical pneumoperitoneum has a number of unusual causes. Intra-abdominal, thoracic, gynecologic, iatrogenic, and miscellaneous etiologies are encountered. It was determined that the pneumoperitoneum in this case was secondary to rough sexual intercourse. We concluded that pneumoperitoneum secondary to nonsurgical causes represents a diagnostic dilemma. In the patient with free intraperitoneal air on plain X-ray one should be suspicious of less common nonsurgical etiologies. The majority of patients will require laparotomy. Thorough sexual and gynecologic/obstetrical history is a valuable adjunct in identifying the patient who does not.
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Thompson SK, Nixon J, MacGregor JH. Soft-tissue case 43. Cecal volvulus: differentiating distended viscus from pneumoperitoneum. Can J Surg 2002; 45:17, 67-8. [PMID: 11837914 PMCID: PMC3692697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
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103
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Mehl ML, Seguin B, Norrdin RW, Geddes S, Withrow SJ. Idiopathic pneumoperitoneum in a dog. J Am Anim Hosp Assoc 2001; 37:549-51. [PMID: 11716029 DOI: 10.5326/15473317-37-6-549] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 13-year-old, neutered male standard poodle with tachypnea and abdominal distension was diagnosed with pneumoperitoneum. Pneumoperitoneum can be due to a perforated gastrointestinal tract, penetrating abdominal wounds, gas-producing bacterial peritonitis, or it can be iatrogenically introduced during surgery. Idiopathic pneumoperitoneum is a condition diagnosed in humans after exclusion of perforated gastrointestinal tract and other known causes of free intra-abdominal gas. This report suggests that dogs may suffer from a similar syndrome.
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104
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Rege SA, Philip U, Quentin N, Deolekar S, Rohandia O. Ruptured splenic abscess presenting as pneumoperitoneum. Indian J Gastroenterol 2001; 20:246-7. [PMID: 11817784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Spontaneous pneumoperitoneum follows perforation of hollow viscus; rarely, it may arise from pulmonary interstitial emphysema or intestinal inflammatory disease. We report a 30-year-old man with ruptured splenic abscess who presented with acute abdomen and had pneumoperitoneum. He was treated with splenectomy and is asymptomatic 2 months later.
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105
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Lal P, Mohan P, Sharma R, Sehgal A, Aggarwal A. Postcoital vaginal laceration in a patient presenting with signs of small bowel perforation: report of a case. Surg Today 2001; 31:466-7. [PMID: 11381516 DOI: 10.1007/s005950170143] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Postcoital vaginal rupture or tear is a well-known entity to the gynecologist, albeit unusual; however, such cases are rarely encountered by the general surgeon. The index case is reported to highlight the rare situation wherein a middle-aged woman underwent laparotomy for a suspected small bowel perforation, which revealed a vaginal tear as the cause of pneumoperitoneum. This case emphasizes the importance of taking a gynecological history and performing a gynecological examination when the clinical diagnosis is uncertain.
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106
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Gessner C, Kaltenhäuser S, Borte G, Keim V. [Pneumatosis cystoides intestinalis, a rare complication of mixed connective tissue disease]. Dtsch Med Wochenschr 2001; 126:1099-102. [PMID: 11588660 DOI: 10.1055/s-2001-17602] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
HISTORY AND ADMISSION FINDINGS A 77-year-old woman presented with diarrhoea and increasing malaise. The patient reported a weight loss of 30 kilogram over the past 12 months due to recurrent episodes of diarrhoea. During previous hospitalisations the diagnosis of a mixed connective tissue disease had been established, and the patient was treated with azathioprine and prednisolone. Clinical findings at presentation included diffuse oedema of the hands, Raynaud's and Sicca syndrome, dysphagia and a distended abdomen and pain on palpation of the left lower abdomen. INVESTIGATIONS A chest X-ray revealed pneumoperitoneum. Contrast medium radiography of gastro-intestinal passage and an abdominal CT with contrast medium confirmed the existence of pneumoperitoneum and showed, in addition, intramural gas in the wall of the dilated jejunum. No contrast medium leakage as an indicator of an open perforation was detectable. DIAGNOSIS, TREATMENT AND CLINICAL COURSE Due to suspected encapsulated perforation a laparotomy was performed. In situ, multiple gas bubbles were found both in the bowel walls and in the mesentery. The small intestine was severely distended, atonic but without evidence for a stenosis. In the absence of an open perforation, the diagnosis of pneumatosis cystoides intestinalis (PCI) was established as the underlying cause of the pneumoperitoneum. Treatment with metronidazole was initiated and the diarrhoea resolved over the following 3 weeks. CONCLUSION PCI is a rare condition, to be considered if pneumoperitoneum is present. One possible underlying cause is an intestinal manifestation of a mixed connective tissue disease.
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Abstract
OBJECTIVES To describe fully pneumatosis intestinalis (PI) in non-neonatal pediatric patients and to characterize those patients with higher risk of poor outcome, including need for surgery and death. METHODS A retrospective chart review was conducted of all patients 30 days of age and older with PI in a tertiary care children's hospital during an 8-year period. Underlying medical condition, presenting signs and symptoms, radiologic grade of pneumatosis, and events that immediately preceded the onset of PI were reviewed, and their correlation with outcome was assessed. RESULTS Thirty-seven episodes of PI occurred in 32 patients. Seventy-eight percent of patients were male, and the median age was 29 months. Major patient diagnostic groups identified with PI included healthy children (22%), patients with organ and bone marrow transplant (22%), patients with decompensated congenital heart disease (12.5%), motility disorders (12.5%), gastroschisis (9%), and short bowel syndrome (6%). The most common events that immediately preceded the onset of PI were noninfectious colitis (32%), acute enteric infection or toxin (27%), bowel ischemia (20%), and gastrointestinal dysmotility (17%). Resolution of PI with medical management occurred in 78% of episodes (good outcome). Twenty-two percent of episodes resulted in a poor outcome: patient death (8%) or surgery (14%). The presence of portal venous gas and low mean serum bicarbonate concentration were the only clinical factors that correlated significantly with poor outcome. Only 25% of patients with pneumoperitoneum required surgery. Poor outcome was seen most commonly in 2 patient diagnostic groups: transplant patients (43% of patients) and decompensated cardiac disease (50% of patients). The event that preceded PI also had an impact on outcome. PI preceded by ischemia or graft versus host disease colitis was associated with poor outcome in 50% and 75% of cases, respectively. CONCLUSIONS PI is a radiologic sign that occurs in a variety of settings in non-neonates. PI preceded by bowel ischemia or graft versus host disease colitis has the worst prognosis, and the presence of portal venous gas and acidosis correlate with poor outcome. Not all patients with pneumoperitoneum require surgical intervention. Overall, outcome of PI in non-neonatal patients was better than that reported in neonates with necrotizing enterocolitis.pneumatosis intestinalis, necrotizing enterocolitis, non-neonatal.
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108
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Chen CH, Yang CC, Yeh YH. Role of upright chest radiography and ultrasonography in demonstrating free air of perforated peptic ulcers. HEPATO-GASTROENTEROLOGY 2001; 48:1082-4. [PMID: 11490805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
BACKGROUND/AIMS The purpose of this study was to determine the value of upright chest radiography and ultrasonography in demonstrating free air of perforated peptic ulcers. METHOLOGY: Eighty-four patients with perforated peptic ulcers receiving both upright chest radiography and ultrasonography before laparotomy. The sensitivity of each modality in demonstrating free air was correlated. RESULTS Among the 84 patients receiving both examinations, free air was demonstrated in only 39 (46%) upright chest radiographs and 46 (55%) ultrasonographs, the direct sign could be demonstrated in 57 (68%) patients by combined radiography and ultrasonography. Besides, the indirect sign of ascites could be demonstrated in 26 (31%) ultrasonographs. CONCLUSIONS Ultrasonography is more sensitive than upright chest radiography to demonstrate free air of perforated peptic ulcers, and it should be considered in those patients of suspected perforated peptic ulcers with negative upright chest radiography. Combined methods of upright chest radiography and ultrasonography can increase the overall sensitivity in demonstrating free air.
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109
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Mansy HA, Royston TJ, Sandler RH. Acoustic characteristics of air cavities at low audible frequencies with application to pneumoperitoneum detection. Med Biol Eng Comput 2001; 39:159-67. [PMID: 11361241 DOI: 10.1007/bf02344798] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Air accumulations within living organisms are sometimes pathologic. An example is free air within the abdomen from perforation of the intestines (a condition called pneumoperitoneum). The objectives of the described research were to define the acoustic signatures of abdominal air cavities at low frequencies and to investigate the feasibility of using these signatures for pneumoperitoneum diagnosis. The central hypothesis was that low-frequency vibro-acoustic property changes are detectable using broad-band acoustic excitation applied at the abdominal surface. Band-limited white noise (0-3200 Hz) was introduced at the abdominal surface of sedated dogs and response was measured by a surface vibro-acoustic sensor. The transfer function and coherence were estimated from these measurements. The presence of pneumoperitoneum caused increased resonances and anti-resonances (p < 0.01). Measures of the latter parameters were proposed and evaluated to quantitatively measure their magnitude. Resonant spectral peaks of more than 3 dB were consistent with pneumoperitoneum (p < 0.01), and both resonance and anti-resonance increased with condition severity (p < 0.03). The data also suggest a possible reduction in the resonant and anti-resonant frequencies with decreasing air cavity volumes (p = 0.14) as supported by theoretical predictions. Finally, anti-resonance was also found to be associated with a drop in coherence. These findings suggest that the proposed technique may be useful in the diagnosis of pneumoperitoneum.
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111
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Abstract
Subcutaneous emphysema of the thorax may follow thoracic operations for a number of essentially benign reasons and does not usually cause much concern to the thoracic surgeon. We report subcutaneous emphysema of the thorax heralding a retroperitoneal colonic perforation in a patient who had undergone coronary artery bypass grafting 3 days previously.
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112
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Hagopian EJ, Steichen FM, Lee KF, Earle DB. Gas extravasation complicating laparoscopic extraperitoneal inguinal hernia repair. Surg Endosc 2001; 15:324. [PMID: 11344443 DOI: 10.1007/s004640040039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2000] [Accepted: 07/24/2000] [Indexed: 11/26/2022]
Abstract
Carbon dioxide can extravasate from the abdominal cavity during insufflation and result in pneumomediastinum, pneumothorax, and subcutaneous emphysema. We report a case of unilateral pneumothorax with pneumomediastinum and subcutaneous emphysema after laparoscopic extraperitoneal bilateral inguinal hernia repair. Additionally, we discuss the pathophysiology, diagnostic work-up, and management of this malady. Because of the natural resolution of CO2 pneumothoraces, observation for asymptomatic patients is appropriate, whereas tube thoracostomy should be reserved for symptomatic patients. It is utmost importance to determine the etiology of gas extravastion and consider other complications such as airway or esophageal injury or pulmonary barotrauma.
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113
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Nakao A, Mimura H, Fujisawa K, Ezawa K, Okamoto T, Iwagaki H, Isozaki H, Takakura N, Tanaka N. Generalized peritonitis due to spontaneously perforated pyometra presenting as pneumoperitoneum: report of a case. Surg Today 2000; 30:454-7. [PMID: 10819486 DOI: 10.1007/s005950050624] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report a rare case of generalized peritonitis due to a ruptured pyometra in an 86-year-old woman, and also conduct a review of the previous Japanese literature. The patient presented with muscle guarding and rebound tenderness. Computed tomography (CT) disclosed a cystic mass in the peritoneal cavity, in which an air-fluid level was noted. Pneumoperitoneum around the uterus due to gas production of anaerobic bacteria was noted on a CT. At laparotomy, the uterus was markedly enlarged with a necrotic area on the uterine fundus, which was found to be perforated. A supravaginal hysterectomy and drainage were performed. We found only eight cases of a ruptured pyometra presenting as pneumoperitoneum in the Japanese literature between 1977 and 1999. The most common cause of pneumoperitoneum is a perforation of the gastrointestinal tract. However, other possible causes, as seen in our patient, should also be taken into consideration. Although it is rare, a perforated pyometra should therefore also be considered when elderly women present with acute abdominal pain.
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114
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Al-Salem AH. Pneumoperitoneum and free meconium without gastrointestinal perforation in a neonate. Saudi Med J 2000; 21:680-2. [PMID: 11500734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
A newborn was referred to our hospital because of poor feeding and abdominal distension and was found to have pneumoperitoneum on abdominal x-ray. At operation there was free intraperitoneal air with no free fluid in the peritoneal cavity. In addition there was free air and meconium retroperitoneally on the left side but there was no evidence of gastrointestinal perforation. This case is rare and unique in that no demonstrable cause for the free air and free meconium could be demonstrated.
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115
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Shibata N, Einami K, Taruishi M, Yamagata K, Takeuchi S, Sotokawa M, Yoshida M, Matsumoto A, Shibata Y, Takeda S, Ogasawara H. [Spontaneous pneumoperitoneum: report of a case]. NIHON SHOKAKIBYO GAKKAI ZASSHI = THE JAPANESE JOURNAL OF GASTRO-ENTEROLOGY 2000; 97:914-9. [PMID: 10934876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Abstract
OBJECTIVE To review causes of nonsurgical pneumoperitoneum (NSP), identify nonsurgical etiologies, and guide conservative management where appropriate. DATA SOURCE We conducted a computerized MEDLINE database search from 1970 to 1999 by using key words pneumoperitoneum and benign, nonsurgical, spontaneous, iatrogenic, barotrauma, pneumatosis, diaphragmatic defects, free air, mechanical ventilation, gynecologic, and pelvic. We identified 482 articles by using these keywords and reviewed all articles. Additional articles were identified and selectively reviewed by using key words laparotomy, laparoscopy, and complications. STUDY SELECTION We reviewed all case reports and reviews of NSP, defined as pneumoperitoneum that was successfully managed by observation and supportive care alone or that required a nondiagnostic laparotomy. DATA SYNTHESIS Each unique cause of nonsurgical pneumoperitoneum was recorded. When available, data on nondiagnostic exploratory laparotomies were noted. Case reports were organized by route of introduction of air into the abdominal cavity: abdominal, thoracic, gynecologic, and idiopathic. CONCLUSIONS Most cases of NSP occurred as a procedural complication or as a complication of medical intervention. The most common abdominal etiology of NSP was retained postoperative air (prevalence 25% to 60%). NSP occurred frequently after peritoneal dialysis catheter placement (prevalence 10% to 34%) and after gastrointestinal endoscopic procedures (prevalence 0.3% to 25%, varying by procedure). The most common thoracic causes included mechanical ventilation, cardiopulmonary resuscitation, and pneumothorax. One hundred ninety-six case reports of NSP were recorded, of which 45 involved surgical exploration without evidence of perforated viscus. The clinician should maintain a high index of suspicion for nonsurgical causes of pneumoperitoneum and should recognize that conservative management may be indicated in many cases.
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Jaarsma AS, Kort E, Bergman KA. Inhalation of helium, a simple test to identify pneumoperitoneum secondary to pulmonary air leakage. Eur J Pediatr 1999; 158:1008. [PMID: 10592083 DOI: 10.1007/s004310051271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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118
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Lipson DA, Tino G, Vaughn D. Tension pneumoperitoneum associated with a pleural-peritoneal shunt. Chest 1999; 116:827-30. [PMID: 10492295 DOI: 10.1378/chest.116.3.827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The differential diagnosis of pneumoperitoneum is broad. We report a case of tension pneumoperitoneum in a patient on mechanical ventilation with initially unrecognized pneumothorax who had an indwelling pleural-peritoneal shunt. The patient developed ventilatory and hemodynamic collapse as air was diverted from the pleural space into the peritoneal cavity. Subsequent abdominal exploration revealed the source of the intra-abdominal air. Placement of a chest thoracostomy tube and removal of the pleural-peritoneal catheter resulted in significant clinical improvement. We suggest that it is important to recognize that pleural-peritoneal catheters may cause tension pneumoperitoneum without obvious concurrent pneumothorax.
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119
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Cancarini GC, Carli O, Cristinelli MR, Manili L, Maiorca R. Pneumoperitoneum in peritoneal dialysis patients. J Nephrol 1999; 12:95-9. [PMID: 10378665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The prevalence and clinical significance of pneumoperitoneum in peritoneal dialysis (PD) patients is not fully defined in current literature and some reports suggest that unlike in non-PD patients, it is rarely caused by gastrointestinal perforation. We reviewed 403 chest X-ray films of the 118 PD patients following our PD program in 1995-96, in order to define the prevalence of pneumoperitoneum. We found pneumoperitoneum in 3.7% of the X-rays (15/403) from five patients (4.2%). Its causes might have been: faulty bag exchange technique in two cases and extension tube exchange in three. One patient suffered from a simultaneous episode of peritonitis. Our data and the literature review suggest that 0-11% of pneumoperitoneum episodes in PD patients are due to gastrointestinal perforation; the main causes generally are abdominal operations and catheter manipulation. The amount of air is not useful in assessing the cause of pneumoperitoneum, which takes some weeks to disappear. Computed tomography is more sensitive than standard X-ray in diagnosis.
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121
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Prischl FC, Wallner M, Schauer W, Balon R, Kramar R. An important differential diagnosis in CAPD patients with sudden onset of fever, vomiting, abdominal pain, and cloudy dialysate. ARCH ESP UROL 1999; 19:81-4. [PMID: 10201348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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122
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Simão C, Gonçalves M, Guerreiro O. [Peritonitis in the neonatal period]. ACTA MEDICA PORT 1998; 11:1127-9. [PMID: 10192990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The authors report a case of 32-week-old newborn, admitted to the Intensive Care Unit for Newborns. Mechanical ventilation was needed from the first day of life. The patient was treated with indomethacin on the second day of life due to patent ductus arteriosus. On the seventh day pneumoperitoneum was diagnosed, emergency surgery was performed revealing perforation of Meckel's diverticulum. Perinatal asphyxia and indomethacin administration probably played an important role in this process.
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123
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Dutta S, Chattopadhyay A, Bhatnagar V, Paul VK. Transillumination for the diagnosis of pneumoperitoneum. TROPICAL GASTROENTEROLOGY : OFFICIAL JOURNAL OF THE DIGESTIVE DISEASES FOUNDATION 1998; 19:162-3. [PMID: 10228444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Transillumination of the abdomen with a cold fibreoptic light source was used for the rapid diagnosis of pneumoperitoneum in a sick premature infant with necrotising enterocolitis. The diagnosis was confirmed at laparotomy. The neonate survived the surgical procedure of resection and anastomosis of the perforated gut. Although additional diagnostic investigations such as X-rays and paracentesis of the abdomen were also positive in this case, transillumination of the abdomen proved to be a useful tool for early diagnosis. Transillumination thus is a valuable modality for early diagnosis of pneumoperitoneum, especially where facilities for in-house X-rays are not available.
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124
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Rowe NM, Kahn FB, Acinapura AJ, Cunningham JN. Nonsurgical pneumoperitoneum: a case report and a review. Am Surg 1998; 64:313-22. [PMID: 9544141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The finding of extraluminal gas on plain radiographs is usually associated with a perforated viscus. But, as this case shows, the finding of pneumoperitoneum is not pathogenic of a perforated viscus or even of a surgical emergency, because there are many benign explanations for a pneumoperitoneum. Perhaps the most important maneuver for differentiating between the two is by performing a through history and physical examination. This in conjunction with either a diagnostic peritoneal lavage, contrast studies, or endoscopic evaluation can help prevent a patient from having needless surgery. The causes of a nonsurgical pneumoperitoneum are described as well as a treatment plan for patients presenting with a nonsurgical pneumoperitoneum.
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Lesser T, Bartel M. [Value of thoracoscopy in thoracic trauma--initial experiences]. Zentralbl Chir 1997; 122:661-5. [PMID: 9412097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The aim of this study was to assess the role of thoracoscopy in the evaluation of the cause of persistent intrathoracic bleeding, air leak, or nuclear basal opacification after blunt thoracic trauma. As a result, a decision to proceed to early thoracotomy could be made, or an attempt of thoracoscopic haemostasis, haematoma evacuation, or fistula closure was possible. Twelve patients (9 male, 3 female, mean age 33,7 years) with blunt thoracic trauma underwent video-assisted thoracoscopy under general anaesthesia with double-lumen endotracheal intubation and one-lung ventilation. The indication for operation was made after assessment of chest X-ray and CT findings, pleural ultrasound, and the volume and quality of pleural drainage. Persistent pneumothorax was shown to be due to traumatic rupture of a bulla in two cases and to parenchymal air-leak from a small lung laceration in two cases, all of which were treated endoscopically. In two cases a diaphragmatic rupture was confirmed as the cause of basal shadowing and in one case a major lower lobe laceration was identified as the cause of a persistent haemopneumothorax. In three cases, a fluid collection which could not be evacuated through a pleural drain was shown to be an organised haematoma and was removed endoscopically. Video-assisted thoracoscopy is helpful in the diagnosis and treatment of thoracic trauma, allowing early recognition of injuries that require thoracotomy. It is indicated for persistent (but not life-threatening) intrathoracic bleeding, unresolving pneumothorax, and unclear basal opacification. Therapeutic parenchymal tissue glue application and suturing as well as local resection and haematoma evacuation can be performed with this technique.
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