Tension pneumoperitoneum during routine colonoscopy

A rare phenomenon creating dilemma for the surgeon: Pneumoperitoneum after colonoscopy

Pneumoperitoneum is free air existence in abdomen and usually caused by the perforation in gastrointestinal system. Peptic ulcer disease is the most common cause of perforation and pneumoperitoneum. The presence of free air in abdomen usually indicates emergency surgery. However, surgical approach is not required in some cases of pneumoperitoneum if there is no evidence of perforation and no sign of peritoneal irritation. Herein, we present an 82-year-old male patient who had pneumoperitoneum after colonoscopy and treated non-surgically.

Tension pneumoperitoneum caused by blunt thoracic trauma

Tension pneumoperitoneum is a rare entity that occurs when free air under pressure accumulates in the abdominal cavity compromising visceral function and blood flow. The case of a 23-year-old man whose chest was run over by the wheels of a truck is presented. He arrived with a severely distended abdomen, significant thoracic trauma, hypoxemia, and elevated airway pressures following intubation. Imaging studies revealed massive intraperitoneal free air. He was treated with a decompressive laparotomy but was not found to have a hollow viscus nor diaphragmatic injury. We hypothesize a possible, as yet unpublished, mechanism: secondary to the patient’s rib fractures and significant torso soft tissue shearing, a defect in the parietal pleura allowed air to track from the thorax inferiorly along subcutaneous and fascial planes, eventually entering into the peritoneal cavity through a violated parietal peritoneum. We present a review of the literature on tension pneumoperitoneum.