Tension pneumoperitoneum after blunt trauma

One More ‘T’ for the Mnemonic of the Management of Pulseless Electrical Activity: Tension Pneumoperitoneum

The approach in Advanced Cardiac Life Support provided by the American Heart Association and the European Resuscitation Council guidelines for the management of pulseless electrical activity emphasizes on the search of reversible causes. Tension pneumoperitoneum is an uncommon surgical emergency encountered in the accident and emergency department. We report a case of pulseless electrical activity secondary to tension pneumoperitoneum in an elderly woman. Restoration of spontaneous circulation was immediately achieved after needle decompression. The management of tension pneumoperitoneum is discussed.

Tension Pneumoperitoneum after Cardiopulmonary Resuscitation

A 61-year-old chronic schizophrenic patient developed sudden cardiac arrest and ventricular fibrillation. Tension pneumoperitoneum was noted after cardiopulmonary resuscitation. The patient had hypotension, lower limbs cyanosis and priapism. The tension was relieved by insertion of a large bore IV catheter through the abdominal wall. Immediately after decompression, the blood pressure improved with the lower limbs cyanosis and priapism resolved.

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 We hypothesize a possible, as yet unpublished, mechanism: secondary to the patient’s rib fractures and significant torso soft tissue shearing, a defect in the parietal pleura allowed air to track from the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.

Tension pneumoperitoneum caused by blunt trauma

Tension pneumoperitoneum (TPP), the accumulation of free intraabdominal air under pressure, is a rare event. TPP usually occurs from bowel surgery or bowel perforations. Less commonly, TPP occurs in the presence of pneumothoraces or during positive pressure ventilation. Trauma has rarely been a reported cause of TPP. The cases of 2 patients with TPP after blunt trauma are reported. The pathophysiology and management of TPP are discussed.