Benign pneumoperitoneum associated with pneumomediastinum and pneumoretroperitoneum in ambulatory outpatients

Three cases of intra-abdominal free air onset associated with COPD treated conservatively

Pneumoperitoneum is caused by respiratory disease in rare cases and can be treated conservatively. It is important to confirm physical abdominal examinations, laboratory data, and radiological findings to avoid unnecessary surgical procedures. The diagnosis of pneumoperitoneum associated with respiratory disease requires the exclusion of other fatal illnesses, especially gastrointestinal perforation.

Airway management: induced tension pneumoperitoneum

Pneumoperitoneum is not always associated with hollow viscus perforation. Such condition is called non-surgical or spontaneous pneumoperitoneum. Intrathoracic causes remain the most frequently reported mechanism inducing this potentially life threatening complication. This clinical condition is associated with therapeutic dilemma. We report a case of a massive isolated pneumoperitoneum causing acute abdominal hypertension syndrome, in a 75 year female, which occurred after difficult airway management and mechanical ventilation. Emergent laparotomy yielded to full recovery. The recognition of such cases for whom surgical management can be avoided is primordial to avoid unnecessary laparotomy and its associated morbidity particularly in the critically ill.

An unusual case of abdominal distension: pneumoperitoneum secondary to pneumomediastinum in a patient with chronic obstructive pulmonary disease

A 68-year-old lady with end-stage chronic obstructive pulmonary disease presented with vomiting and abdominal pain. On examination her abdomen was grossly distended, diffusely tender and hyper-resonant. Imaging showed dilated loops of bowel and free air in the abdomen with no intestinal perforation. The free abdominal air had come down from the thorax by dissecting down around the oesophagus. A pneumomediastinum was present in her chest, secondary to her extensive emphysematous disease. She was treated conservatively and her pneumomediastinum resolved several weeks later, with subsequent resumption of intestinal motility and return to premorbid function. Surgical intervention would not have helped her condition.

Pneumoperitoneum after Rough Sexual Intercourse

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.