1
|
Nieto Morales ML, Linares Bello CC, El Khatib Ghzal Y, Benítez Rivero S, Fernandez Del Castillo Ascanio M, Souweileh Arencibia C. The pathologies of migrants who travel by boat documented on imaging. RADIOLOGIA 2024; 66:366-373. [PMID: 39089796 DOI: 10.1016/j.rxeng.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/03/2024] [Indexed: 08/04/2024]
Abstract
The migration phenomenon is increasingly common worldwide. It is essential for radiologists to be aware of the endemic diseases of the migrant's country as well as the characteristics of the journey to be able to understand and interpret radiological findings when admitted to our centre. This article aims to use imaging from our centre to describe the most common pathologies that migrant patients present with after long journeys by boat.
Collapse
Affiliation(s)
- M L Nieto Morales
- Radiodiagnóstico, Complejo Hospitalario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain.
| | - C C Linares Bello
- Radiodiagnóstico, Complejo Hospitalario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain
| | - Y El Khatib Ghzal
- Radiodiagnóstico, Complejo Hospitalario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain
| | - S Benítez Rivero
- Radiodiagnóstico, Complejo Hospitalario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain
| | | | - C Souweileh Arencibia
- Radiodiagnóstico, Complejo Hospitalario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Canary Islands, Spain
| |
Collapse
|
2
|
Samee M, Samee A, Zubair Y, Samee A. Tension Pneumoperitoneum: A Rare Complication of Cardiopulmonary Resuscitation (CPR). Cureus 2024; 16:e60743. [PMID: 38903345 PMCID: PMC11187782 DOI: 10.7759/cureus.60743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/22/2024] Open
Abstract
Tension pneumoperitoneum is a surgical emergency. Although rare, failure to diagnose and treat the condition may be lethal. Hence, being aware of this phenomenon, particularly in scenarios involving cardiopulmonary resuscitation (CPR), is important. Existing literature emphasises immediate abdominal needle decompression as the initial management followed by close monitoring and keeping a low threshold for surgical intervention as a definitive measure. We decided to write up this case report to raise awareness that a tension pneumoperitoneum can result as a complication of CPR, a well-known and widely practiced algorithm.
Collapse
Affiliation(s)
- M Samee
- General Medicine, University Hospital of North Midlands, Stoke On Trent, GBR
| | - A Samee
- General and Colorectal Surgery, Royal Oldham Hospital, Manchester, GBR
- Medicine, Medical University, Plovdiv, BGR
| | - Y Zubair
- General and Colorectal Surgery, Royal Oldham Hospital, Manchester, GBR
| | - A Samee
- General and Colorectal Surgery, Royal Oldham Hospital, Manchester, GBR
| |
Collapse
|
3
|
Tuladhar S, Katwal S, Joshi HO. Benign pneumoperitoneum in a neonate receiving positive pressure ventilation: A case report and clinical insights. Radiol Case Rep 2024; 19:1629-1633. [PMID: 38327553 PMCID: PMC10847833 DOI: 10.1016/j.radcr.2024.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 02/09/2024] Open
Abstract
The presence of air in the peritoneal cavity demonstrated radiographically as the crescent of air under the diaphragm is termed pneumoperitoneum. The causative agents may be divided into spontaneous, traumatic, iatrogenic, and miscellaneous. The majority (∼ 90%) of cases are attributed to hollow viscus perforation which requires immediate surgical attention. Neonatal pneumoperitoneum is a surgical emergency unless proven otherwise. A distinct entity termed benign pneumoperitoneum occurs in the absence of clinical and paraclinical features of peritonitis. Benign pneumoperitoneum may be caused by various thoracic, abdominal, and gynecological conditions. In neonates with respiratory distress pneumoperitoneum is a frequent association especially when treated with mechanical ventilation. The air leak phenomenon leads to air tracking from the ruptured alveoli along the interstitium to the mediastinum then to the retroperitoneum and ultimately into the peritoneal cavity. Such patients usually do not require surgical intervention and are managed conservatively. Knowledge of the existence of benign pneumoperitoneum helps to avoid unnecessary surgery thereby reducing operative morbidity and mortality.
Collapse
Affiliation(s)
- Sasmita Tuladhar
- Department of Radiology, Kanti Children's Hospital, Kathmandu, Nepal
| | - Shailendra Katwal
- Department of Radiology, Dadeldhura Subregional Hospital, Dadeldhura, Nepal
| | - Hari Om Joshi
- Department of Radiology, Kanti Children's Hospital, Kathmandu, Nepal
| |
Collapse
|
4
|
Mahmoud Daoud R, Daoud SM, Almansoor M, Ali NF, Salman ES. Navigating Asymptomatic Idiopathic Pneumoperitoneum: A Case Report and a Literature Review. Cureus 2024; 16:e55687. [PMID: 38586695 PMCID: PMC10997878 DOI: 10.7759/cureus.55687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Pneumoperitoneum refers to the presence of free air in the abdominal cavity, typically indicating viscus perforation requiring urgent surgical intervention. Occasionally, pneumoperitoneum occurs without organ perforation, termed 'spontaneous' or 'non-surgical' pneumoperitoneum. We present the case of a 65-year-old male referred to the emergency department after a seizure episode. The patient reported no abdominal pain or fever, and examination revealed no other signs of peritonitis. An erect chest X-ray showed air under the diaphragm, and a subsequent computed tomography (CT) scan confirmed free intraperitoneal air in the abdomen. The patient underwent a prompt exploratory laparotomy to assess for abdominal perforation, but the findings were negative. He had an uneventful post-operative hospital course and was discharged nine days after admission. This case underlines the importance of considering spontaneous idiopathic pneumoperitoneum (SIP) in asymptomatic patients and discusses management options.
Collapse
Affiliation(s)
| | - Salma M Daoud
- General Practice, Albaraka Fertility Hospital, Manama, BHR
| | - Manar Almansoor
- School of Medicine, Royal College of Surgeons in Ireland, Busaiteen, BHR
| | - Noora F Ali
- General Surgery, Salmaniya Medical Complex, Manama, BHR
| | - Esra S Salman
- General Surgery, Salmaniya Medical Complex, Manama, BHR
| |
Collapse
|
5
|
Bedard M, McInnis M, Banton K. Spontaneous pneumoperitoneum presenting as an acute abdomen. J Surg Case Rep 2024; 2024:rjae049. [PMID: 38370600 PMCID: PMC10873165 DOI: 10.1093/jscr/rjae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 01/19/2023] [Indexed: 02/20/2024] Open
Abstract
Most cases of pneumoperitoneum with associated peritonitis are due to perforation of a hollow viscus. In cases where hollow viscus perforation is not the cause, the pneumoperitoneum is classified as spontaneous and typically can be further subcategorized into thoracic, abdominal, gynecologic, and idiopathic categories. Spontaneous pneumoperitoneum is classically seen in asymptomatic patients, however in a small number of cases patients can present with a concomitant peritonitis. This case report presents a patient that had signs of sepsis and peritonitis with moderate pneumoperitoneum on computed tomography (CT) imaging but was found to have no perforated hollow viscus after an extensive operative and non-operative work up.
Collapse
Affiliation(s)
- Megan Bedard
- Trauma/Acute Care Surgery, Swedish Medical Center, Englewood, CO 80113, United States
| | - Madison McInnis
- Trauma/Acute Care Surgery, Swedish Medical Center, Englewood, CO 80113, United States
| | - Kaysie Banton
- Trauma/Acute Care Surgery, Swedish Medical Center, Englewood, CO 80113, United States
| |
Collapse
|
6
|
Alvi AT, Santiago LE, Shankar M, Aneja P. Benign Pneumoperitoneum Following Mitral Valve Replacement. Cureus 2024; 16:e53216. [PMID: 38425634 PMCID: PMC10902870 DOI: 10.7759/cureus.53216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
The pneumoperitoneum refers to the presence of free air inside the abdominal cavity. This finding is usually a sequela of a gastrointestinal tract perforation. Still, in rare instances, it can present after cardiac surgery due to the proximity of the peritoneal cavity and pericardium, allowing air to enter the peritoneal cavity. Our patient was a 63-year-old female who initially presented for revision of the mitral valve replacement. A chest X-ray on postoperative day 13 revealed a 6.6 cm lucency under the right diaphragm suggestive of pneumoperitoneum. She was discharged after serial chest X-rays revealed a decrease in the size of the pneumoperitoneum. Twelve days later, our patient was readmitted, as another chest X-ray revealed that the size of the pneumoperitoneum was again increasing. An endoscopy was performed, but it did not reveal any lesions or etiology that would lead to a leak from the gastrointestinal tract. Finally, due to the benign nature of the pneumoperitoneum and the decrease in its size over the following days, we opted for conservative management, and she was discharged again. This case emphasizes the rare occurrence of benign pneumoperitoneum post-mitral valve surgery. While surgery may not always be required for asymptomatic cases, careful vigilance post-cardiac surgery remains crucial to detect potential abdominal complications promptly.
Collapse
Affiliation(s)
- Ali Tariq Alvi
- Internal Medicine, HCA Florida Westside Hospital, Plantation, USA
- Internal Medicine, HCA Florida Northwest Hospital, Margate, USA
| | - Luis E Santiago
- Internal Medicine, HCA Florida Westside Hospital, Plantation, USA
| | - Murali Shankar
- Internal Medicine, HCA Florida Westside Hospital, Plantation, USA
| | - Pallavi Aneja
- Internal Medicine, HCA Florida Westside Hospital, Plantation, USA
| |
Collapse
|
7
|
Mahmoud A, Alyassin N, Baghal E, Yuridullah R, Cavanagh Y, Grossman MA. Incidence of Pneumoperitoneum After Gastrostomy Tube Removal. Cureus 2023; 15:e47684. [PMID: 38021967 PMCID: PMC10673697 DOI: 10.7759/cureus.47684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
We present the case of an 88-year-old man with a previous medical history of severe colitis and colonic strictures who presented with hematemesis. The patient was found to have a lower esophageal ulcer without any signs of perforation. Esophagogastroduodenoscopy (EGD) revealed a scar in the greater curvature of the stomach from a previously removed gastrostomy tube two months prior. On CT imaging, an incidental finding of pneumoperitoneum was also found alongside stomach perforation near the healing scar. Due to the lack of evidence of any other colonic perforation, the patient was believed to have developed this pneumoperitoneum status post-gastrectomy tube removal two months prior to presentation. Pneumoperitoneum has a wide range of presenting symptoms that vary in severity and nature, and our patient failed to present with any physical or laboratory signs of infection. Over the course of the next four months, the patient was monitored with serial CT scans, during which the pneumoperitoneum resolved. In this report, we present a case of a patient who was found to develop pneumoperitoneum post-gastric tube removal and its complete resolution without surgical or procedural intervention.
Collapse
Affiliation(s)
- Anas Mahmoud
- Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA
| | - Nizar Alyassin
- Internal Medicine, St. Joseph's Regional Medical Center, Paterson, USA
| | - Eyad Baghal
- Gastroenterology, St. Joseph's Regional Medical Center, Paterson, USA
| | - Ruhin Yuridullah
- Gastroenterology, St. Joseph's Regional Medical Center, Paterson, USA
| | - Yana Cavanagh
- Gastroenterology, St. Joseph's Regional Medical Center, Paterson, USA
| | - Matthew A Grossman
- Interventional Gastroenterology, St. Joseph's Regional Medical Center, Paterson, USA
| |
Collapse
|
8
|
Ubukata Y, Sohda M, Sakai M, Nakazawa N, Hara K, Sano A, Ogawa H, Shirabe K, Saeki H. Idiopathic pneumoperitoneum diagnosed following high-energy motor vehicular trauma:a case report. THE JOURNAL OF MEDICAL INVESTIGATION 2022; 69:155-157. [PMID: 35466140 DOI: 10.2152/jmi.69.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Intra-abdominal free gas is a finding of extra-intestinal gas in the abdominal cavity on radiography or CT, mainly suggesting gastrointestinal perforation and necessitating emergency surgery. Idiopathic pneumoperitoneum is diagnosed when there is no obvious gastrointestinal perforation, but there is presence of free gas in the abdominal cavity with an unidentifiable cause. Herein, we report a case of idiopathic pneumoperitoneum secondary to high-energy trauma following a car rollover accident. A 95-year-old man was transferred to our clinic after a car-to-car rollover accident. He had abrasions on his right upper arm and left abdomen that appeared to be the result of the accident;however, no other apparent traumatic injuries were noted. There was no pain in the abdomen, and peritoneal irritation symptoms were also not noted. A CT scan showed fine free air. Although idiopathic pneumoperitoneum could not be ruled out, considering the patient's background and the possibility of traumatic small bowel perforation, emergency surgery was performed. A thorough search of the abdominal cavity was performed;however, the surgery was completed without an obvious perforation site. Idiopathic pneumoperitoneum should be considered as a differential disease in cases who have free air on abdominal CT but clinically lack obvious inflammatory reaction findings. J. Med. Invest. 69 : 155-157, February, 2022.
Collapse
Affiliation(s)
- Yasunari Ubukata
- Department of General Surgery, Graduate School of Medical Sciences, Gunma University, Maebashi, Japan
| | - Makoto Sohda
- Department of General Surgery, Graduate School of Medical Sciences, Gunma University, Maebashi, Japan
| | - Makoto Sakai
- Department of General Surgery, Graduate School of Medical Sciences, Gunma University, Maebashi, Japan
| | - Nobuhiro Nakazawa
- Department of General Surgery, Graduate School of Medical Sciences, Gunma University, Maebashi, Japan
| | - Keigo Hara
- Department of General Surgery, Graduate School of Medical Sciences, Gunma University, Maebashi, Japan
| | - Akihiko Sano
- Department of General Surgery, Graduate School of Medical Sciences, Gunma University, Maebashi, Japan
| | - Hiroomi Ogawa
- Department of General Surgery, Graduate School of Medical Sciences, Gunma University, Maebashi, Japan
| | - Ken Shirabe
- Department of General Surgery, Graduate School of Medical Sciences, Gunma University, Maebashi, Japan
| | - Hiroshi Saeki
- Department of General Surgery, Graduate School of Medical Sciences, Gunma University, Maebashi, Japan
| |
Collapse
|
9
|
Ibrahimi A, Dumani S, Kuci S, Dogjani A. Pneumoperitoneum After a Redo Cardiac Surgery: Patience Can Lead to Victory. Cureus 2022; 14:e23663. [PMID: 35371867 PMCID: PMC8971066 DOI: 10.7759/cureus.23663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/24/2022] Open
Abstract
Pneumoperitoneum after cardiac surgery is not usual. It occurs during extended sternotomy, which is sometimes accompanied by the opening of the peritoneal cavity or in cases after previous sternotomies. A 73-year-old man was operated on two times within one month due to prosthetic mitral valve dehiscence. The second operation was accompanied by a lot of complications, including blood loss, respiratory failure, massive pleural effusion, sternal infection, pneumomediastinum, and pneumoperitoneum. The presence of pneumoperitoneum alerted the possibility of intra-abdominal cavitary organ perforation. No surgical approach was chosen because there were no signs of peritonitis. The patient was discharged to home in a good health situation. Sixteen months later, he was recovered at the hospital for heart failure, and after abdominal CT, benign pneumoperitoneum was observed in the abdominal cavity again. There was no explanation for this finding, but again conservative treatment was chosen. He was discharged for the third time from the hospital in good condition.
Collapse
|
10
|
Maliyakkal AM, Naushad VA, Al Mokdad OI, Hanana F, Basheer SM, Palaki JA. Gas Under Diaphragm: A Rare Case of Ruptured Liver Abscess With Gas Forming Organism. Cureus 2022; 14:e21672. [PMID: 35242462 PMCID: PMC8884540 DOI: 10.7759/cureus.21672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2022] [Indexed: 11/07/2022] Open
Abstract
Acute abdominal pain with free air under the diaphragm visible on chest/abdomen X-ray (pneumoperitoneum) is a medical emergency. Most of such cases of pneumoperitoneum are attributable to perforated hollow viscus; however, other possibilities like rupture of liver abscess (by a gas-forming organism) also need to be considered. Further imaging like a CT scan might help in the diagnosis and would also obviate the need for laparotomy in some of such cases. We report a case of acute abdominal pain with gas under the diaphragm due to a ruptured liver abscess caused by Klebsiella pneumoniae. The patient was managed successfully with ultrasound-guided percutaneous aspiration and insertion of a drain along with antibiotics and supportive measures, and no laparotomy was performed.
Collapse
|
11
|
Vedenin YI, Oreshkin AY, Kuchin DA, Efanova VA. [Spontaneous idiopathic pneumoperitoneum in a patient with COVID-19]. Khirurgiia (Mosk) 2022:73-76. [PMID: 36398959 DOI: 10.17116/hirurgia202211173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The authors present a patient with COVID-19 and spontaneous idiopathic pneumoperitoneum. A 77-year-old man suffering from coronary artery disease, diabetes mellitus and cognitive disorders was diagnosed with bilateral pneumonia and COVID-19. Oxygen support through a face mask was prescribed. After 21 days, oxygen saturation decrease and mild abdominal symptoms required CT-based examination. Pneumoperitoneum without pneumothorax and pneumomediastinum was revealed. Explorative laparotomy found no abdominal diseases. According to the literature, spontaneous pneumoperitoneum in patients with COVID-19 is usually associated with high pressure oxygen therapy, but not always associated with intrathoracic complications. Conservative treatment may be appropriate in patients with spontaneous pneumoperitoneum, but any unclear findings can require surgery.
Collapse
Affiliation(s)
- Yu I Vedenin
- Volgograd State Medical University, Volgograd, Russia
| | - A Yu Oreshkin
- Volgograd State Medical University, Volgograd, Russia
| | - D A Kuchin
- Volgograd State Medical University, Volgograd, Russia
| | - V A Efanova
- Volgograd State Medical University, Volgograd, Russia
| |
Collapse
|
12
|
Johnson CL, Gomes C, Cheng J, Lebares CC. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac219. [PMID: 35599993 PMCID: PMC9116581 DOI: 10.1093/jscr/rjac219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Spontaneous pneumoperitoneum in a patient with a tracheostomy tube following cardiopulmonary resuscitation is exceedingly rare, with little experimental nor observational data to guide evidence-based management. We present the case of a 75-year-old woman with a tracheostomy tube who developed pneumoperitoneum following CPR. The patient experienced pulseless electrical activity arrest requiring nine rounds of chest compressions to return to spontaneous circulation. Computerized tomography demonstrated pneumothoraces, subcutaneous emphysema and extensive intraperitoneal, extraperitoneal and retroperitoneal free air without evidence of visceral perforation. The patient’s abdomen was distended without tenderness, guarding or rebound. She had a white blood cell count mildly elevated from her baseline levels. The management plan of serial abdominal exams without operative intervention was chosen given the absence of clinical and laboratory signs of peritonitis. This case highlights the importance of developing a standardized management algorithm for patients with pneumoperitoneum in the setting of tracheostomy tubes without evidence of perforation.
Collapse
Affiliation(s)
- Christopher L Johnson
- School of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Camilla Gomes
- Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Justin Cheng
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Carter C Lebares
- Correspondence address. Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA. Tel: 415-602-3735; E-mail:
| |
Collapse
|
13
|
Chang W, Udo M, Schulze B. A case of spontaneous idiopathic tension pneumoperitoneum successfully managed with bedside pig-tail catheter. J Surg Case Rep 2021; 2021:rjab528. [PMID: 34858581 PMCID: PMC8634065 DOI: 10.1093/jscr/rjab528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
We present a 67-year-old gentleman with a high perioperative mortality and morbidity risk who presented with spontaneous idiopathic tension pneumoperitoneum that was successfully managed with bedside pig-tail catheter insertion. Here we also discuss other potential non-surgical aetiologies of pneumoperitoneum.
Collapse
Affiliation(s)
- Wendy Chang
- General Surgery Department, Mackay Base Hospital, Mackay, QLD, Australia
| | - Mieko Udo
- General Surgery Department, Mackay Base Hospital, Mackay, QLD, Australia
| | - Bettina Schulze
- General Surgery Department, Mackay Base Hospital, Mackay, QLD, Australia
| |
Collapse
|
14
|
Yeo IH, Kim YJ. Two case reports of pneumatosis intestinalis in patients with cancer: is surgical management mandatory? Clin Exp Emerg Med 2021; 8:237-241. [PMID: 34649412 PMCID: PMC8517457 DOI: 10.15441/ceem.20.153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/01/2021] [Indexed: 11/23/2022] Open
Abstract
Pneumatosis intestinalis (PI) can be classified into two groups. Primary PI is idiopathic, and patients can recover spontaneously. In contrast, secondary PI is considered fatal due to the high mortality rate associated with mesenteric ischemia. Herein, we describe two patients with PI and concurrent pneumoperitoneum. Both patients were receiving targeted anticancer therapy, yet neither developed abdominal pain nor fatal symptoms. One of the patients underwent surgery, while the other was managed conservatively. Even though there were no complications, the patient who underwent surgery was hospitalized for 34 days, whereas the one who was managed conservatively was hospitalized for only five days. Usually, patients with cancer receiving chemotherapy are immunosuppressed and susceptible to infections. Therefore, based on the patients’ clinical features, surgical management of patients with cancer who develop PI after receiving anticancer chemotherapy should be done prudently.
Collapse
Affiliation(s)
- In Hwan Yeo
- Department of Emergency Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Yun Jeong Kim
- Department of Emergency Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| |
Collapse
|
15
|
Sakaguchi T, Kotsuka M, Yamamichi K, Sekimoto M. Management of incidentally detected idiopathic pneumoperitoneum: A case report and literature review. Int J Surg Case Rep 2021; 87:106463. [PMID: 34628336 PMCID: PMC8501495 DOI: 10.1016/j.ijscr.2021.106463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Pneumoperitoneum usually requires emergency surgery. Asymptomatic idiopathic pneumoperitoneum is a rare subgroup of pneumoperitoneum for which a management algorithm has not been established. PRESENTATION OF CASE In an 88-year-old female patient, pneumoperitoneum was found incidentally by chest computed tomography during a periodic follow-up for sarcoidosis. Emergency admission was ordered for conservative treatment. Upper gastrointestinal endoscopy revealed edematous mucosa in the entire gastric vestibule. After being discharged on the 7th day, her clinical course was uneventful over 2 months of follow-up. DISCUSSION The initial clinical manifestations of pneumoperitoneum are variable and range widely from asymptomatic to septic shock. The etiology of pneumoperitoneum in our patient implied a subclinical visceral perforation that resolved without treatment. We advocate an algorithm for the initial management of pneumoperitoneum according to the extent of peritonitis and impaired conditions. CONCLUSION Incidentally found asymptomatic pneumoperitoneum does not always require intervention. Careful and repeated physical assessment with investigation of underlying etiology is important in the management of pneumoperitoneum.
Collapse
Affiliation(s)
- Tatsuma Sakaguchi
- Department of Gastrointestinal Surgery, Medical Center, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi-city, Osaka 570-8507, Japan.
| | - Masaya Kotsuka
- Department of Gastrointestinal Surgery, Medical Center, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi-city, Osaka 570-8507, Japan
| | - Keigo Yamamichi
- Department of Gastrointestinal Surgery, Medical Center, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi-city, Osaka 570-8507, Japan
| | - Mitsugu Sekimoto
- Department of Gastrointestinal Surgery, Medical Center, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi-city, Osaka 570-8507, Japan
| |
Collapse
|
16
|
Udelsman B, Lee K, Qadan M, Lillemoe KD, Chang D, Lindvall C, Cooper Z. Management of Pneumoperitoneum: Role and Limits of Nonoperative Treatment. Ann Surg 2021; 274:146-154. [PMID: 31348040 DOI: 10.1097/sla.0000000000003492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to compare morbidity and mortality between nonoperative and operative treatment of pneumoperitoneum. BACKGROUND Pneumoperitoneum is a potentially life-threatening condition that has been traditionally treated with surgical intervention. Adequately powered studies comparing treatment outcomes are lacking. METHODS Chart review and computer-assisted abstraction were used to identify patients with pneumoperitoneum at 5 hospitals from 2010 to 2015. Patients with recent abdominal procedures or contained perforation were excluded. Patients were grouped by treatment modality: comfort measures only (CMO), nonoperative treatment, or operative intervention. CMO included only symptom-palliation, whereas nonoperative therapy included all interventions (antibiotics, peritoneal drains, resuscitation) excluding surgery. Outcomes were mortality, discharge disposition, and 30-day complications. Covariates included demographics, comorbidities, and acuity at presentation. RESULTS Forty patients received CMO, 202 underwent nonoperative treatment, and 199 underwent operative intervention. CMO patients had 98% 30-day mortality. There was no difference in 30-day (P = 0.64) or 2-year mortality (P = 0.53) between patients treated nonoperatively and operatively. Compared with patients treated operatively, patients treated nonoperatively were more likely to have a colorectal source of pneumoperitoneum (37% vs 31%; P = 0.03). Using logistic regression, operative treatment was associated with increased dependence on enteral tube feeding or total parenteral nutrition [odds ratio (OR) 4.30, 95% confidence interval (CI), 1.99-9.29] and nonhome discharge (OR 3.61, 95% CI, 1.81-7.17). Among patients with clinical peritonitis, operative treatment was associated with reduced mortality (OR 0.17, 95% CI, 0.04-0.80). CONCLUSIONS Operative intervention is associated with reduced mortality in patients with pneumoperitoneum and peritonitis. In the absence of peritonitis, operative treatment is associated with increased morbidity and nonhome discharge.
Collapse
Affiliation(s)
- Brooks Udelsman
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Katherine Lee
- Department of Surgery, University of California San Diego, San Diego, CA
- Center for Surgery and Public Health, Brigham & Women's Hospital, Boston, MA
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - David Chang
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Charlotta Lindvall
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham & Women's Hospital, Boston, MA
- Department of Surgery, Brigham and Women's Hospital, Boston, MA
| |
Collapse
|
17
|
Grewal JS, Mayer S, Beaty J, Formaro D. A Rare Case of Spontaneous Idiopathic Pneumoperitoneum Presenting as Abdominal Pain. Cureus 2021; 13:e15158. [PMID: 34178490 PMCID: PMC8216704 DOI: 10.7759/cureus.15158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Idiopathic spontaneous pneumoperitoneum is caused by free air in the peritoneum when no established cause has been diagnosed. We present the case of a 61-year-old male with idiopathic spontaneous pneumoperitoneum, which started as abrupt abdominal pain. He described burning abdominal pain radiating to his right shoulder and endorsed symptoms of nausea, abdominal bloating, and heartburn but denied fever, chills, or vomiting. Chest radiograph and computed tomography demonstrated massive amounts of free air under the diaphragm, concluding an extensive pneumoperitoneum. He was diagnosed by standard imaging modalities and then underwent diagnostic laparoscopy, which did not reveal any areas of perforation. Subsequently, the patient had an uncomplicated recovery. The complexity of diagnosis and treatment has made it difficult for surgeons to treat spontaneous pneumoperitoneum patients.
Collapse
|
18
|
Chibani I, Nouira F, Marzouki M, Ben Ahmed Y, Boukesra T, Charieg A, Jlidi S. Idiopathic neonatal pneumoperitoneum. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2020.101697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
19
|
Hollerweger A, Maconi G, Ripolles T, Nylund K, Higginson A, Serra C, Dietrich CF, Dirks K, Gilja OH. Gastrointestinal Ultrasound (GIUS) in Intestinal Emergencies - An EFSUMB Position Paper. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:646-657. [PMID: 32311749 DOI: 10.1055/a-1147-1295] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
An interdisciplinary group of European experts summarizes the value of gastrointestinal ultrasound (GIUS) in the management of three time-critical causes of acute abdomen: bowel obstruction, gastrointestinal perforation and acute ischemic bowel disease. Based on an extensive literature review, statements for a targeted diagnostic strategy in these intestinal emergencies are presented. GIUS is best established in case of small bowel obstruction. Metanalyses and prospective studies showed a sensitivity and specificity comparable to that of computed tomography (CT) and superior to plain X-ray. GIUS may save time and radiation exposure and has the advantage of displaying bowel function directly. Gastrointestinal perforation is more challenging for less experienced investigators. Although GIUS in experienced hands has a relatively high sensitivity to establish a correct diagnosis, CT is the most sensitive method in this situation. The spectrum of intestinal ischemia ranges from self-limited ischemic colitis to fatal intestinal infarction. In acute arterial mesenteric ischemia, GIUS may provide information, but prompt CT angiography is the gold standard. On the other end of the spectrum, ischemic colitis shows typical ultrasound features that allow correct diagnosis. GIUS here has a diagnostic performance similar to CT and helps to differentiate mild from severe ischemic colitis.
Collapse
Affiliation(s)
- Alois Hollerweger
- Department of Radiology, Hospital Barmherzige Brüder, Salzburg, Austria
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, "L.Sacco" University Hospital, Milan, Italy
| | - Tomas Ripolles
- Department of Radiology, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Kim Nylund
- Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - Antony Higginson
- Department of Radiology, Queen-Alexandra-Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom of Great Britain and Northern Ireland
| | - Carla Serra
- Internal Medicine and Gastroenterology, S. Orsola University Hospital, Bologna, Italy
| | - Christoph F Dietrich
- Department of General Internal Medicine Kliniken Hirslanden Beau-Site, Salem und Permanence, Bern, Switzerland
| | - Klaus Dirks
- Gastroenterology and Internal Medicine, Rems-Murr-Klinikum Winnenden, Germany
| | - Odd Helge Gilja
- Haukeland University Hospital, National Centre for Ultrasound in Gastroenterology, Bergen, Norway
| |
Collapse
|
20
|
Adachi W, Matsushita T, Yashiro Y, Imura J, Shiozawa H, Kishimoto K. Clinical characteristics of pneumoperitoneum with pneumatosis intestinalis detected using computed tomography: A descriptive study. Medicine (Baltimore) 2020; 99:e22461. [PMID: 33019436 PMCID: PMC7535758 DOI: 10.1097/md.0000000000022461] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Pneumoperitoneum has always been considered a surgical emergency as it represents a perforation of the gastrointestinal tract. Although several cases of pneumoperitoneum with pneumatosis intestinalis (PI) have been reported, the characteristics of such cases remain unclear. The current study aimed to clarify the clinical characteristics of pneumoperitoneum cases with PI detected using computed tomography (CT).This descriptive study was conducted at a single center. In a total of 18,513 abdominal CT scans obtained between January 2010 and February 2017, extraluminal free air was detected in 254 examinations of 182 cases. The medical records and CT images of these 182 patients were retrospectively analyzed.Pneumoperitoneum with PI was detected through 23 examinations in 21 cases, and the average age of the patients was 80.1 years. The frequency was 0.12% in all abdominal CT examinations, but 24.7% in the 85 cases with extraluminal free air, excluding iatrogenic air. PI was classified as benign in 20 cases and as life-threatening in 1 case. The majority of cases with benign PI showed good general and local findings and little leukocytosis, while the case with life-threatening PI showed severe conditions. No evidence of bowel wall discontinuity, segmental bowel-wall thickening, perivisceral fat stranding, and abscesses were observed. Ascites were detected less frequently in the cases with PI than in the other pneumoperitoneum cases (P < .01). Pneumoperitoneum and PI occasionally recurred, and PI and/or extraluminal free air generally disappeared quickly.Pneumoperitoneum with PI is a relatively common condition in older patients, and the majority of cases are caused by benign PI. The characteristics of pneumoperitoneum cases with benign PI include well-maintained physical conditions, normal laboratory data, absence of CT findings indicative of peritonitis, and infrequent ascites. In pneumoperitoneum cases with PI, predicting whether the PI is benign or life-threatening is clinically very important, whereas the presence of extraluminal free air is considered to be insignificant.
Collapse
Affiliation(s)
| | | | - Yasuaki Yashiro
- Department of Internal Medicine, Fujimi-Kogen Hospital, Fujimi-Kogen Medical Center, 11100, Ochiai, Fujimi, Suwa-gun, Nagano, Japan
| | | | | | | |
Collapse
|
21
|
Sidiqi MM, Fletcher D, Billah T. The enigma of asymptomatic idiopathic pneumoperitoneum: A dangerous trap for general surgeons. Int J Surg Case Rep 2020; 76:33-36. [PMID: 33010611 PMCID: PMC7530197 DOI: 10.1016/j.ijscr.2020.09.149] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Idiopathic pneumoperitoneum is an extremely rare condition that can easily be misdiagnosed as an acute abdomen. Awareness of this phenomenon can help avoid unnecessary surgical intervention and the potential associated morbidities. PRESENTATION OF CASE A 76 year old man presented to hospital with dyspnoea and productive cough and was diagnosed with an infective exacerbation of COPD. He subsequently had a CTPA which showed a significant amount of free intraperitoneal gas in the upper abdomen. He was completely asymptomatic from this with no abdominal pain, distension, or significant rise in inflammatory markers. Of note, he had never had previous abdominal surgery or endoscopic procedures. He showed no signs of peritonism and was closely observed with serial abdominal examinations for 24 h. He subsequently tolerated oral intake and was discharged 8 days after admission. DISCUSSION Spontaneous pneumoperitoneum can be due to a variety of intrathoracic, gynaecologic, intra-abdominal and iatrogenic causes. This is a rare case of asymptomatic idiopathic pneumoperitoneum where no clear aetiology or risk factors were found for his free intraperitoneal gas. To the best of our knowledge there have only been two published case reports in the English literature describing idiopathic pneumoperitoneum in a patient that was completely asymptomatic from it. CONCLUSION As a general surgeon it is important to be aware of the non-surgical causes of pneumoperitoneum. Knowledge of this uncommon condition may help reduce the risk of unnecessary laparotomy.
Collapse
Affiliation(s)
| | - David Fletcher
- Kalgoorlie Regional Hospital, Western Australia, Australia.
| | - Tasfeen Billah
- Kalgoorlie Regional Hospital, Western Australia, Australia.
| |
Collapse
|
22
|
Hanna M, Ng C, Slater K. Small Bowel Diverticulosis As a Cause of Chronic Pneumoperitoneum. Cureus 2020; 12:e7303. [PMID: 32313744 PMCID: PMC7164552 DOI: 10.7759/cureus.7303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pneumoperitoneum, or the accumulation of free air in the peritoneal cavity, is commonly associated with visceral perforation, mandating emergent surgical intervention. Non-surgical pneumoperitoneum, where visceral perforation is not the cause, does not commonly require surgical management. Chronic pneumoperitoneum secondary to small bowel diverticulosis is rare. Of all gastrointestinal diverticular diseases, jejunoileal diverticulosis is the rarest form. We describe a case of chronic pneumoperitoneum in an 83-year-old male presenting with intermittent abdominal distension and constipation over five years resulting in many presentations to his rural hospital. There were never any associated signs of sepsis such as fever or tachycardia. A computed tomography scan revealed large volume pneumoperitoneum without evidence of perforated viscera or free fluid. An elective diagnostic laparoscopy revealed extensive small bowel diverticular disease. One of the diverticuli exhibited pneumotosis intestinalis where bubbles of gas were noted within the diverticulum wall and mesentery in the local vicinity. Given the extent of the small bowel diverticular disease, the patient's advanced age, and relative lack of symptoms, bowel resection was not undertaken and the patient was managed conservatively. This article illustrates a case of chronic pneumoperitoneum due to small bowel diverticulosis. It highlights the differential diagnoses for chronic pneumoperitoneum, increases awareness of this rare and challenging condition, and portrays the utility of conservative management avoiding major surgery and its potential complications.
Collapse
Affiliation(s)
- Mark Hanna
- General Surgery, Princess Alexandra Hospital, Brisbane, AUS
| | - Chu Ng
- General Surgery, Princess Alexandra Hospital, Brisbane, AUS
| | | |
Collapse
|
23
|
Elrobaa IH, Khan AH, Ahmad MK, Elamatha AJ, Elserhy MD, Eltahir E, Saifeldeen KA. Huge hydro pneumoperitoneum reported as complication of perforated duodenal ulcer with interesting images. Pan Afr Med J 2020; 34:217. [PMID: 32180889 PMCID: PMC7060911 DOI: 10.11604/pamj.2019.34.217.20829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 12/03/2019] [Indexed: 11/11/2022] Open
Abstract
This case has interesting images of huge hydro pneumoperitoneum. It is a rare view in the medical practice and a good point to learn one of the complications of perforated duodenal ulcer and failure of omental patch operation. We reported a case of acute abdominal pain with hydro pneumoperitoneum that appeared as an air fluid line in X-ray. The patient had an omental patch surgery. Two days after the operation he got severe abdominal pain. The X-ray images showed significant huge hydro pneumoperitoneum. He underwent urgent surgical intervention for exploration that detected a large amount of gases, a biliary free fluid and a leak from duodenal ulcer. Omental buttressing was then performed.
Collapse
Affiliation(s)
| | | | | | | | | | - Elfatih Eltahir
- Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | | |
Collapse
|
24
|
Simlawo K, Alassani F, Tchangaï B, Sambiani DM. Pneumopéritoine spontané idiopathique: à propos d’une observation. Pan Afr Med J 2020; 35:76. [PMID: 32537079 PMCID: PMC7250192 DOI: 10.11604/pamj.2020.35.76.11193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 11/08/2017] [Indexed: 11/11/2022] Open
Abstract
Le pneumopéritoine résulte, dans la majorité des cas, d'une perforation du tractus gastro-intestinal dont le traitement est habituellement chirurgical. Son caractère spontané est rare, avec dans ce cas, une présentation inhabituelle qui met le chirurgien devant un dilemme diagnostic et thérapeutique. Nous rapportons un cas de pneumopéritoine spontané chez un sujet de 77 ans ayant bien évolué sous traitement non opératoire. Nous discutons des modalités de prise en charge de cette entité peu commune.
Collapse
Affiliation(s)
- Kpatékana Simlawo
- Service de Chirurgie Générale du Centre Hospitalier Régional Lomé-Commune, Lomé, Togo
| | - Fousséni Alassani
- Service de Chirurgie Viscérale du Centre Hospitalier Universitaire Sylvanus Olympio, Lomé, Togo
| | - Boyodi Tchangaï
- Service de Chirurgie Viscérale du Centre Hospitalier Universitaire Sylvanus Olympio, Lomé, Togo
| | | |
Collapse
|
25
|
Hannan E, Saad E, Hoashi S, Toomey D. The clinical dilemma of the persistent idiopathic pneumoperitoneum: A case report. Int J Surg Case Rep 2019; 63:10-12. [PMID: 31499325 PMCID: PMC6734534 DOI: 10.1016/j.ijscr.2019.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/12/2019] [Accepted: 08/14/2019] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Idiopathic pneumoperitoneum (IP) is a rare phenomenon which merits special attention. It is defined as free intraperitoneal air which is not caused by viscus perforation and does not require surgical intervention. It is generally considered a diagnosis of exclusion and often poses a genuine diagnostic dilemma. PRESENTATION OF CASE We present an unusual case of persistent pneumoperitoneum with no identifiable cause which was found incidentally on a computed tomography (CT) scan in a patient with chronic cough and no prior surgical history. Serial consults revealed no abdominal symptoms or signs. He was managed conservatively and remains asymptomatic despite having a persistent IP on serial radiology. DISCUSSION To our knowledge, our case is the first in the literature of an idiopathic pneumoperitoneum that persisted on subsequent radiology and was managed successfully without surgical intervention. This is a highly important case for all practicing general surgeons to learn from as knowledge of this phenomenom may help avoid unnecessary surgical intervention and potential morbidities associated with this. CONCLUSION IP is a diagnosis of exclusion which should only be made after surgical and non-surgical causes have been outruled. In the absence of signs of peritonitis and evidence of gastrointestinal perforation on CT, a conservative approach is warranted, allowing patients to avoid unnecessary surgical intervention.
Collapse
Affiliation(s)
- Enda Hannan
- Department of General Surgery, Regional Hospital Mullingar, Ireland.
| | - Eltaib Saad
- Department of General Surgery, Regional Hospital Mullingar, Ireland
| | - Shu Hoashi
- Department of General Surgery, Regional Hospital Mullingar, Ireland
| | - Desmond Toomey
- Department of General Surgery, Regional Hospital Mullingar, Ireland
| |
Collapse
|
26
|
Park J, Jung E. Spontaneous pneumoperitoneum in two extremely preterm infants during nasal intermittent positive pressure ventilation. Pediatr Int 2019; 61:424-425. [PMID: 30983051 DOI: 10.1111/ped.13805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/25/2018] [Accepted: 02/05/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Jaehyun Park
- Department of Pediatrics, Keimyung University, Dongsan Medical Center, Daegu, South Korea
| | - Eunyoung Jung
- Department of Pediatric Surgery, Keimyung University, Dongsan Medical Center, Daegu, South Korea
| |
Collapse
|
27
|
Miller MA, O'Meara LB, Hessler LK, Shah P, Haase DJ. Woman With Abdominal Pain. Ann Emerg Med 2018; 72:321-329. [PMID: 30144867 DOI: 10.1016/j.annemergmed.2018.03.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - Lindsay B O'Meara
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD; Department of Surgery, R Adams Cowley Shock Trauma Center, Baltimore, MD
| | - Lindsay K Hessler
- Department of Surgery, Baltimore, MD; Department of Surgery, University of Maryland Medical Center, Baltimore, MD
| | - Paulesh Shah
- Department of Surgery, Baltimore, MD; Department of Surgery, R Adams Cowley Shock Trauma Center, Baltimore, MD
| | - Daniel J Haase
- Department of Emergency Medicine, Baltimore, MD; Department of Emergency Medicine, R Adams Cowley Shock Trauma Center, Baltimore, MD
| |
Collapse
|
28
|
Anand S, Patcharu R, Yadav DK, Kandasamy D, Sharma S. Does Pneumomediastinum and Pneumoretroperitoneum Always Necessitate Surgical Treatment? Indian J Pediatr 2018; 85:688-689. [PMID: 29305765 DOI: 10.1007/s12098-017-2578-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 12/14/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Sachit Anand
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Ravi Patcharu
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Devendra Kumar Yadav
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | | | - Shilpa Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| |
Collapse
|
29
|
Gupta R. Spontaneous Pneumoperitoneum in Pediatric Patients: Dilemmas in Management. J Indian Assoc Pediatr Surg 2018; 23:115-122. [PMID: 30050258 PMCID: PMC6042170 DOI: 10.4103/jiaps.jiaps_221_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Context: Pneumoperitoneum is typically a surgical emergency, particularly in neonates. However, pneumoperitoneum can rarely present without gastrointestinal perforation which is known as spontaneous pneumoperitoneum. Aims: This study aims to analyze the outcome of pediatric patients with spontaneous pneumoperitoneum and describe our experience. Settings and Design: A retrospective study performed from January 2014 to May 2017. Materials and Methods: The study included all pediatric patients admitted in a tertiary care institute. Results: There were 9 patients with 5 males and 4 females, out of which 7 were neonates. At presentation, respiratory distress was a common complaint (8/9). 5 out of all patients developed abdominal distension. Associated malformations were seen in 5 patients. Pneumoperitoneum was preceded by mechanical ventilation in 5 patients. Abdominal examination revealed soft distension with relaxed abdominal wall in 7, while marked distension was present in 2 cases. Features suggestive of peritonitis were absent in all the patients. Abdominal radiographs revealed free air in all, while, radiographic evidence of pneumothorax was seen in 2 patients. Conservative management without any operative intervention was performed in 3 patients with favorable outcome. Laparotomy was performed in 1 patient; negative for any perforation and outcome was unfavorable. In 5 patients, abdominocentesis was performed followed by abdominal drain placement. No patient had any evidence of leakage of intestinal contents from gastrointestinal tract after insertion of abdominal drain. Favorable outcome was present in 5 patients. Out of 4 cases with unfavorable outcome, 3 patients were having esophageal atresia. Conclusions: A high index of suspicion for spontaneous pneumoperitoneum must be present when dealing with pediatric patients, especially neonates with pneumoperitoneum and without clinical signs of peritonitis. A comprehensive clinical evaluation with sepsis screen must be carried out to supplement the diagnosis. Pneumoperitoneum in pediatric patients, especially neonates, is not always an absolute indication for surgery.
Collapse
Affiliation(s)
- Rahul Gupta
- Department of Paediatric Surgery, SMS Medical College, Jaipur, Rajasthan, India
| |
Collapse
|
30
|
Fujiwara K, Ohsaka H, Nagasawa H, Takeuchi I, Jitsuiki K, Kondo A, Omori K, Ishikawa K, Yanagawa Y. Massive intraperitoneal free air induced by pneumothorax and pneumomediastinum. Int J Surg Case Rep 2018; 49:78-80. [PMID: 29966954 PMCID: PMC6039890 DOI: 10.1016/j.ijscr.2018.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/21/2018] [Accepted: 06/22/2018] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Pneumoperitoneum (PP), or air within the abdominal cavity, is frequently a harbinger of serious abdominal pathology and often represents visceral perforation. We herein report a case of combined massive intraperitoneal free air, pneumothorax and pneumomediastinum but emergency laparotomy was negative. PRESENTATION OF CASE A sixty-seven-year-old man was found unconscious on a road after being hit by a car. On arrival, he showed swelling of the head and flail chest. Computed tomography (CT) demonstrated cerebral contusion, multiple bilateral rib fractures, minute subcutaneous emphysema and a left hemothorax. As his consciousness and respiratory function deteriorated, tracheal intubation with mechanical ventilation with positive end-expiratory pressure was executed on the second day. On the third day, the CT scan revealed the new appearance of pneumomediastinum and massive free air in his intraperitoneal space. Emergency laparotomy was negative. DISCUSSION The 'air leak' phenomenon, in which an alveolar air cell ruptures into the perivascular and peribronchial interstitial tissues, is a well-recognized consequence of positive end-expiratory pressure therapy. Accordingly, the deterioration of traumatic pneumothorax and/or the occurrence of pneumomediastinum after mechanical ventilation was the most likely cause of the PP in the present case. However, it remains possible that a minute unrecognized diaphragmatic injury caused the massive PP in the present case. CONCLUSION We herein described a case of PP that occurred after mechanical ventilation in a patient with multiple injuries, but which did not originate from perforation of the gastrointestinal tract. It is most likely that the PP had an intrathoracic cause.
Collapse
Affiliation(s)
- Kei Fujiwara
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan
| | - Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan
| | - Ikuto Takeuchi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan
| | - Kei Jitsuiki
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan
| | - Akihiko Kondo
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan
| | - Kazuhiko Omori
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan
| | - Kouhei Ishikawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Japan.
| |
Collapse
|
31
|
Abstract
Pneumoperitoneum is often associated with surgical complications or intra-abdominal sepsis. While commonly deemed a surgical emergency, pneumoperitoneum in a minority of cases does not involve a viscus perforation or require urgent surgical management; these cases of “spontaneous pneumoperitoneum” can stem from a variety of etiologies. We report a case of a 72-year-old African American male with a history of metastatic pancreatic adenocarcinoma who presented with new-onset abdominal distention and an incidentally discovered massive pneumoperitoneum with no clear source of perforation on surveillance imaging. His exam was non-peritonitic, so no surgical intervention was recommended. He was treated with bowel rest, intravenous antibiotics, and hydration. He had a relatively benign clinical course with preserved gastrointestinal function and had complete resolution of his pneumoperitoneum on imaging two months after discharge. This case highlights the importance of considering non-surgical causes of pneumoperitoneum, as well as conservative management, when approaching patients with otherwise benign abdominal exams.
Collapse
Affiliation(s)
- Harry Wang
- Internal Medicine, Thomas Jefferson University Hospitals, Philadelphia, USA
| | - Vivek Batra
- Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, USA
| |
Collapse
|
32
|
Sambursky JA, Kumar S, Orban M, Janolo E, Neychev V. Non-surgical Pneumoperitoneum in the Setting of Gram-negative Sepsis. Cureus 2018; 10:e2493. [PMID: 29922534 PMCID: PMC6003802 DOI: 10.7759/cureus.2493] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Pneumoperitoneum is described as the presence of free air in the peritoneal cavity. In the majority of cases, it is the manifestation of abdominal viscus perforation, requiring an emergent surgical exploration. In rare cases, however, no evidence of perforation of the gastrointestinal or genitourinary tracts can be found at exploration, and in such cases, the pneumoperitoneum is referred to as non-surgical pneumoperitoneum. We present a case of an 87-year-old man who developed a non-surgical pneumoperitoneum in the setting of gram-negative sepsis. The patient was admitted for treatment of obstructive uropathy and sepsis secondary to a gram-negative urinary tract infection. Despite the initial resuscitation and antibiotic therapy, his hospital course was complicated by worsening abdominal discomfort, and a chest radiograph revealed free air under the diaphragm. He was taken to the operating room for an emergent surgical exploration that revealed no visceral perforation or other possible surgical causes. He tolerated and recovered from surgery well, and had a complete resolution of pneumoperitoneum in the early post-surgery period, per radiographic imaging. This interesting case highlights a rare case of idiopathic nonsurgical pneumoperitoneum in the setting of gram-negative sepsis. Additionally, we discuss considering non-surgical etiologies for patients without clinical signs or surgical evidence of perforation.
Collapse
Affiliation(s)
| | - Sundeep Kumar
- Internal Medicine, University of Central Florida College of Medicine, Orlando, USA
| | - Molly Orban
- Ophthalmology, Osceola Regional Medical Center, Kissimmee, USA
| | - Esteban Janolo
- Internal Medicine, Osceola Regional Medical Center, Kissimmee, USA
| | - Vladimir Neychev
- Department of Clinical Sciences, University of Central Florida College of Medicine, Orlando, USA
| |
Collapse
|
33
|
Mohamed Nasr Eldin H, Bahaaeldin K, Shalaby A. Extra-peritoneal air mimicking pneumoperitoneum in an infant. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
34
|
Malgras B, Placé V, Dohan A, Lo Dico R, Duron S, Soyer P, Pocard M. Natural History of Pneumoperitoneum After Laparotomy: Findings on Multidetector-Row Computed Tomography. World J Surg 2017; 41:56-63. [PMID: 27456496 DOI: 10.1007/s00268-016-3648-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Postoperative pneumoperitoneum after abdominal surgery represents a diagnostic challenge. This study was designed to analyze the appearance of pneumoperitoneum on computed tomography after uncomplicated abdominal surgery through laparotomy. METHODS The database of the department of digestive surgery was retrospectively queried to identify all patients who underwent abdominal surgery through laparotomy during a 13-month period. This initial search retrieved a total of 384 consecutive patients. Criteria for inclusion in this study were: (a) the operation was performed in our institution, (b) the patient had computed tomography examination postoperatively, and (c) the patient had no postoperative grade ≥3 complication. RESULTS Postoperative pneumoperitoneum was visible in 38/80 patients (47.5 %), with a mean volume of 15 ± 22.8 (SD) cm3 and multiple locations in 32/38 patients (84 %). Postoperative pneumoperitoneum was observed in 22/26 patients (85 %) until day 5 postoperative, 14/34 patients (41 %) between day 6 and day 15 postoperative, and in 2/21 patients (9.5 %) after day 15 postoperative. Its volume decreased when the time interval between surgery and computed tomography increased. Results of multivariate analysis showed that the time interval between surgery and computed tomography was the single independent variable that was associated with the presence of postoperative pneumoperitoneum. CONCLUSIONS Postoperative pneumoperitoneum is a frequent finding on computed tomography in the early period following abdominal surgery and commonly with multiple locations. Although commonly observed before day 5 postoperative, its presence must be considered as an alarming finding after day 7 postoperative, if present in a single location with a volume >20 cm3.
Collapse
Affiliation(s)
- Brice Malgras
- Department of Digestive Surgery, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France. .,Department of Digestive Surgery, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75475, Paris Cedex 10, France.
| | - Vinciane Placé
- Department of Abdominal and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France
| | - Anthony Dohan
- Department of Abdominal and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France.,Université Diderot-Paris 7, Sorbonne Paris Cité, 10 avenue de Verdun, 75010, Paris, France
| | - Réa Lo Dico
- Department of Digestive Surgery, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France.,Université Diderot-Paris 7, Sorbonne Paris Cité, 10 avenue de Verdun, 75010, Paris, France
| | - Sandrine Duron
- French Armed forces Center for Epidemiology and Public Health, Marseille, France
| | - Philippe Soyer
- Department of Abdominal and Interventional Imaging, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France.,Université Diderot-Paris 7, Sorbonne Paris Cité, 10 avenue de Verdun, 75010, Paris, France
| | - Marc Pocard
- Department of Digestive Surgery, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France.,Université Diderot-Paris 7, Sorbonne Paris Cité, 10 avenue de Verdun, 75010, Paris, France
| |
Collapse
|
35
|
Perforated Duodenal Diverticulum with Subtle Pneumoretroperitoneum on Abdominal X-Ray. Case Rep Emerg Med 2017; 2017:7089573. [PMID: 29201469 PMCID: PMC5671692 DOI: 10.1155/2017/7089573] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/25/2017] [Accepted: 09/17/2017] [Indexed: 11/17/2022] Open
Abstract
Abdominal pain is one of the most common presenting complaints at the Emergency Department (ED). Given the myriad of possible differential diagnoses for abdominal pain, it becomes more important to diagnose conditions requiring emergent surgical intervention early. We present a case of an elderly male patient with abdominal pain secondary to perforated hollow viscus, subtle evidence of pneumoretroperitoneum on the initial supine abdominal X-ray, and review the signs of pneumoperitoneum and pneumoretroperitoneum on plain abdominal X-rays.
Collapse
|
36
|
Khan A, Merrett N, Selvendran S. Stomach perforation post cardiopulmonary resuscitation-A case report. Int J Surg Case Rep 2017; 40:43-46. [PMID: 28938127 PMCID: PMC5608500 DOI: 10.1016/j.ijscr.2017.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/17/2017] [Accepted: 08/17/2017] [Indexed: 11/10/2022] Open
Abstract
Stomach perforation after cardiopulmonary resuscitation is rare. CPR performed by non-medical personnel is the main cause. Training of medical and non-medical persons in CPR is to be encouraged. Correct management of airway during CPR is important. High degree of vigilance is required in patients presenting after CPR.
Introduction Stomach perforation after cardiopulmonary resuscitation is a rare finding. This is mainly caused by incorrect management of the airway during CPR performed by non-medical personnel. Presentation of case We report a case of 72 year old female who sustained a stomach perforation during prolonged CPR in an out of hospital arrest situation. This was diagnosed on a computed tomography scan of the abdomen requiring midline laparotomy and a primary repair of the stomach. Discussion The training of medical and non-medical persons in cardiopulmonary resuscitation is to be encouraged. However it should be emphasized that any technique which breaches the normal integrity of the body can itself lead to life-threatening complications. Conclusion A high degree of vigilance is required in patients presenting after a cardiac arrest and CPR.
Collapse
Affiliation(s)
- Aasim Khan
- Department of General & Hepato-Biliary Surgery, Bankstown Hospital, Sydney, Australia.
| | - Neil Merrett
- Department of General & Hepato-Biliary Surgery, Bankstown Hospital, Sydney, Australia
| | - Selwyn Selvendran
- Department of General & Hepato-Biliary Surgery, Bankstown Hospital, Sydney, Australia
| |
Collapse
|
37
|
Essarghini M, Tarchouli M, Elfahssi M, Aitali A, Bounaim A. [A rare case of spontaneous massive pneumoperitoneum]. Pan Afr Med J 2017; 26:192. [PMID: 28674585 PMCID: PMC5483357 DOI: 10.11604/pamj.2017.26.192.11554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 01/16/2017] [Indexed: 11/12/2022] Open
Abstract
Le pneumopéritoine spontané est une affection rare caractérisée par la présence d’un épanchement d’air libre dans la cavité péritonéale en l’absence de toute cause évidente, nous rapportons une observation d’un pneumopéritoine massif de découverte scanographique dont l’exploration clinique, biologique, radiologique et cœlioscopique n’a aboutie a aucune étiologie décelable. Cette observation met le jour sur une entité clinique rarement vue dans notre pratique constituant un véritable piège diagnostic, sa connaissance éviterait des laparotomies blanches inutiles et surtout agressives pour nos patients. La cœlioscopie semble être un moyen chirurgical peu invasif pour les formes douteuses et permet un diagnostic visuel en éliminant une perforation d’organe creux.
Collapse
Affiliation(s)
- Mohamed Essarghini
- Service de Chirurgie 1 de l'Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc
| | - Mohamed Tarchouli
- Service de Chirurgie 1 de l'Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc
| | - Mohamed Elfahssi
- Service de Chirurgie 1 de l'Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc
| | - Abdelmounim Aitali
- Service de Chirurgie 1 de l'Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc
| | - Ahmed Bounaim
- Service de Chirurgie 1 de l'Hôpital Militaire d'Instruction Mohamed V, Rabat, Maroc
| |
Collapse
|
38
|
Bonny R, Moh EN, Aké YL, Kouassi AS, Midékor K, Kouao JP, Coulibaly C. Extensive pneumoscrotum and pneumoperitoneum simulating a compound inguino scrotal hernia in a neonate. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
39
|
Abdelmohsen SM, Osman MA. Frequent postoperative gas expansion of the abdominal drain bag for a case of idiopathic neonatal pneumoperitoneum: A case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
40
|
Idiopathic neonatal pneumoperitoneum, a case report. Int J Surg Case Rep 2017; 31:250-253. [PMID: 28199933 PMCID: PMC5310177 DOI: 10.1016/j.ijscr.2017.01.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 01/20/2017] [Accepted: 01/20/2017] [Indexed: 11/20/2022] Open
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 with negative finding. We had noted that the bag of the abdominal drain was expanded with gas every 2days, we replace the bag by new one every 2days for 10days 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.
Collapse
|
41
|
Makki AM. The Pattern of Causes of Pneumoperitoneum-induced Peritonitis: Results of an Empirical Study. J Microsc Ultrastruct 2017; 5:28-31. [PMID: 30023234 PMCID: PMC6014263 DOI: 10.1016/j.jmau.2016.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 04/29/2016] [Accepted: 04/30/2016] [Indexed: 11/15/2022] Open
Abstract
Pneumoperitoneum refers to presence of free air within the peritoneal cavity, “Pneumoperitoneum induced Peritonitis” is synonymous of surgical pneumoperitoneum, as the leak of air and visceral contents contaminates the peritoneal cavity, producing peritonitis which mandates surgery. This entire pneumoperitoneum may result from inflammatory conditions, traumatic injury, neoplasia, anastomotic leak and vascular causes. The objectives of this study is to determine the incidence of Pneumoperitoneum-induced Peritonitis (surgical pneumoperitoneum) in emergency exploratory laparotomies, to identify the common anatomical sites of perforations and to review the pathological etiology of these cases. Review of 450 cases of emergency exploratory laparotomy cases performed in King Abdulaziz University Hospital from January 2011 to December 2015, among them 131 cases with radiologically documented pneumoperitoneum were selected to be involved in the study of surgical pneumoperitoneum, the anatomical site of perforation and the exact underlying pathology were documented. 29% of exploratory laparotomy cases were found to have pneumoperitoneum, mainly in the in the gastroduodenal region, inflammatory conditions as peptic ulcer disease or diverticulitis were the underlying cause of most of perforations. Pneumoperitoneum frequently indicates bowel injury or disease, hence it is called surgical pneumoperitoneum, Perforations are commonly found in gastro-duodenal area, the inflammatory conditions are responsible for the vast majority of cases, however presence of air with intact bowel, is called Non-Surgical or spontaneous Pneumoperitoneum, which has to be approached conservatively.
Collapse
Affiliation(s)
- Ahmed M Makki
- College of Medicine-King Abdulaziz University Jeddah S.A
| |
Collapse
|
42
|
Estridge P, Akoh JA. Recurrent spontaneous pneumoperitoneum: A surgical dilemma. Int J Surg Case Rep 2016; 30:103-105. [PMID: 28012321 PMCID: PMC5192032 DOI: 10.1016/j.ijscr.2016.11.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 11/26/2016] [Accepted: 11/27/2016] [Indexed: 11/18/2022] Open
Abstract
36-year-old woman admitted with abdominal pain and fever found to have spontaneous pneumoperitoneum. Despite raised inflammatory markers, she declined surgical intervention citing successful conservative management of previous episodes. A trial of conservative management may be appropriate even in the presence of raised inflammatory markers. It must always be borne in mind that clinical deterioration represents an indication for surgical intervention.
Introduction Spontaneous pneumoperitoneum describes free air within the peritoneal cavity in the absence of iatrogenic causes or a perforated viscus. This report describes a rare case in which despite raised inflammatory markers, a trial of conservative management proved adequate. Case report AM is a 36-year old woman who presented multiple times with abdominal pain and radiologically proven pneumoperitoneum. Her medical history included self catheterisation and cerebrovascular stenosis (Moyamoya disease), asymptomatic gallstones, livedo reticularis and peptic ulceration. On her index admission she exhibited raised inflammatory markers and fever. Despite these findings, emboldened by similar presentations in the past with no cause found, she declined surgical intervention with no untoward consequences. Discussion Most patients presenting with non-surgically induced pneumpoeritoneum display signs of peritonism including pyrexia and raised inflammatory markers. For such patients, surgical intervention is usually required to find and rectify the cause. Conclusion A trial of conservative management may be appropriate in patients with spontaneous pneumoperitoneum but it must always be borne in mind that clinical deterioration represents an indication for surgical intervention.
Collapse
Affiliation(s)
- Polly Estridge
- Department of Surgery, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth PL6 8DH, United Kingdom
| | - Jacob A Akoh
- Department of Surgery, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth PL6 8DH, United Kingdom.
| |
Collapse
|
43
|
Ahmed K, Amine EGM, Abdelbaki A, Jihene A, Khaoula M, Yamina H, Mohamed B. Airway management: induced tension pneumoperitoneum. Pan Afr Med J 2016; 25:125. [PMID: 28292087 PMCID: PMC5325505 DOI: 10.11604/pamj.2016.25.125.9038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/14/2016] [Indexed: 12/13/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Khedher Ahmed
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia
| | | | - Azouzi Abdelbaki
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia
| | - Ayachi Jihene
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia
| | - Meddeb Khaoula
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia
| | - Hamdaoui Yamina
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia
| | - Boussarsar Mohamed
- Medical Intensive Care Unit, Farhat Hached University Hospital, Sousse, Tunisia
| |
Collapse
|
44
|
Lewinson RT, Lewinson RE, Graves PS. Spontaneous pneumoperitoneum with subcutaneous emphysema. BMJ Case Rep 2016; 2016:bcr-2016-215815. [PMID: 27358100 DOI: 10.1136/bcr-2016-215815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ryan T Lewinson
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | | |
Collapse
|
45
|
Vinzens F, Zumstein V, Bieg C, Ackermann C. Two similar cases of elderly women with moderate abdominal pain and pneumoperitoneum of unknown origin: a surgeon's successful conservative management. BMJ Case Rep 2016; 2016:bcr-2016-215816. [PMID: 27229749 DOI: 10.1136/bcr-2016-215816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Patients presenting with abdominal pain and pneumoperitoneum in radiological examination usually require emergency explorative laparoscopy or laparotomy. Pneumoperitoneum mostly associates with gastrointestinal perforation. There are very few cases where surgery can be avoided. We present 2 cases of pneumoperitoneum with unknown origin and successful conservative treatment. Both patients were elderly women presenting to our emergency unit, with moderate abdominal pain. There was neither medical intervention nor trauma in their medical history. Physical examination revealed mild abdominal tenderness, but no clinical sign of peritonitis. Cardiopulmonary examination remained unremarkable. Blood studies showed only slight abnormalities, in particular, inflammation parameters were not significantly increased. Finally, obtained CTs showed free abdominal gas of unknown origin in both cases. We performed conservative management with nil per os, nasogastric tube, total parenteral nutrition and prophylactic antibiotics. After 2 weeks, both were discharged home.
Collapse
Affiliation(s)
- Fabrizio Vinzens
- Department of Visceral Surgery, St Claraspital Basel, Basel, Schweiz, Switzerland
| | - Valentin Zumstein
- Department of Visceral Surgery, St Claraspital Basel, Basel, Schweiz, Switzerland
| | - Christian Bieg
- Department of Radiology, St Claraspital Basel, Basel, Schweiz, Switzerland
| | - Christoph Ackermann
- Department of Visceral Surgery, St Claraspital Basel, Basel, Schweiz, Switzerland
| |
Collapse
|
46
|
Spontaneous pneumoperitoneum in pediatric patients: A case series. Int J Surg Case Rep 2016; 22:55-8. [PMID: 27058151 PMCID: PMC4832033 DOI: 10.1016/j.ijscr.2016.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 03/02/2016] [Accepted: 03/13/2016] [Indexed: 12/12/2022] Open
Abstract
Pneumoperitoneum may not always be an ominous sign in the pediatric population. Cases of non-surgical pneumoperitoneum in the pediatric population are scarce. The clinical picture of a patient should be the primary determinant of management. Conservative measures can be used in pediatrics with isolated pneumoperitoneum. If the diagnosis is still unclear, clinical correlation should take precedence.
Introduction Pneumoperitoneum frequently results in emergent surgery because it typically indicates an abdominal viscus perforation. However, this may not always be the case. There have been few recent reports in the pediatric population that document cases of pneumoperitoneum which could be considered for non-surgical management. Presentation of case This case series presents three different instances of pediatric patients with radiographic evidence of pneumoperitoneum who were subsequently found to have no perforated viscus following surgical intervention. Conclusion We recommend that in the absence of peritoneal signs, fever, leukocytosis, significant abdominal pain, distension, or clinical deterioration, non-operative management be considered in pediatric patients with radiographic signs of pneumoperitoneum.
Collapse
|
47
|
Biggs NG, Koehler H. Pneumatosis intestinalis with cyst perforation. ANZ J Surg 2016; 88:E469-E470. [PMID: 26748822 DOI: 10.1111/ans.13434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Nathan G Biggs
- General Surgery Unit, Wimmera Health Care Group, Horsham, Victoria, Australia.,Department of General Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Heinz Koehler
- General Surgery Unit, Wimmera Health Care Group, Horsham, Victoria, Australia
| |
Collapse
|
48
|
Abstract
Plain abdominal radiographs remain an important aid for clinicians in the diagnosis of gastrointestinal perforation, especially in neonates and very sick children where clinical features of peritonitis may not be as prominent. Suggestive radiographic features are not always very obvious, especially when taken in the supine position and may lead to delayed or missed diagnosis. Through a pictorial review of plain radiographs, this article highlights a number of documented features of gastrointestinal perforation on X-ray in the paediatric setting, which increases the accuracy of diagnosis.
Collapse
Affiliation(s)
- Olugbenga T. Awolaran
- Department of Clinical Health Care, Faculty of Health and Life Sciences, Oxford Brookes University, Marston, Oxford, UK
| |
Collapse
|
49
|
He TZ, Xu C, Ji Y, Sun XY, Liu M. Idiopathic neonatal pneumoperitoneum with favorable outcome: A case report and review. World J Gastroenterol 2015; 21:6417-6421. [PMID: 26034380 PMCID: PMC4445122 DOI: 10.3748/wjg.v21.i20.6417] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 01/24/2015] [Accepted: 02/11/2015] [Indexed: 02/06/2023] Open
Abstract
Neonatal pneumoperitoneum is a surgical emergency indicative of gastrointestinal perforation that requires immediate treatment to prevent death. 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 more rare and benign condition that does not yet have a definite cause. Hence, inexperienced surgeons may have a difficult time providing the right treatment for idiopathic pneumoperitoneum. We report a case of a neonate with a massive pneumoperitoneum who obtained a favorable outcome without surgical intervention. Nonetheless, the cause of pneumoperitoneum remains unclear. We hypothesize that the right sized perforation (range: 2 mm to 4 mm in diameter) at the anterior wall of the stomach is needed for pneumoperitoneum to occur. As the baby cries (aerophagia), the air in the stomach accumulates until it can enter the intraperitoneal cavity through the leak compressed by gastric peristalsis, hence forming a large pneumoperitoneum. Small amounts of gastric juice are able to penetrate the gastric wall; therefore, no signs or symptoms of peritonitis occur. The gastric leak self-seals, preventing further passage of the air, allowing the intraperitoneal free gas to dissipate gradually. This case demonstrated that laparotomy can be avoided in neonates with idiopathic pneumoperitoneum if a timely diagnosis is established.
Collapse
|
50
|
Alassaf M. Recurring spontaneous aseptic pneumoperitoneum presenting secondary to an unrelated chief complaint: A case report. Int J Surg Case Rep 2014; 7C:96-8. [PMID: 25603306 PMCID: PMC4336396 DOI: 10.1016/j.ijscr.2014.10.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 10/05/2014] [Accepted: 10/10/2014] [Indexed: 11/27/2022] Open
Abstract
The case study details a patient's multiple admissions with aseptic pneumoperitoneum. Rough description of his management course is provided. The fact that no cause for his pneumoperitoneum is clearly illustrated. The patient's last presentation was managed conservatively with success. This supports the idea that aseptic pneumoperitoneum can be treated conservatively.
INTRODUCTION Pneumoperitoneum, observed by radiography, is typically associated with the perforation of hollow viscous. More than 90% of all cases of pneumoperitoneum are the result of a gastrointestinal tract perforation. These patients usually present with signs of acute peritonitis and require immediate surgical exploration and intervention. However, rare cases of idiopathic spontaneous pneumoperitoneum do occur without any indication of visceral perforation and other known causes of the free intraperitoneal gas. PRESENTATION OF CASE A 66-year-old male presented to the emergency department on three separate occasions with similar episodes six months apart. Upon physical examination and subsequent testing, chest radiography revealed the presence of free intraperitoneal gas. A computerized tomography (CT) was performed in which pneumatosis and pneumoperitoneum was reported with the first two admissions and both laparotomies were negative. This patient continues to be followed for prostate cancer and bony metastases. All subsequent CT scans (last performed 01/2014) have shown no acute or chronic abdominal pathology and no obstructions. He also had upper and lower endoscopies in 2011, which were negative. DISCUSSION This case revealed very different finding than anticipated. The patient presented to the emergency department with symptoms unrelated to the CT findings of free intraperitoneal gas. On two separate occasions, the patient underwent a laparotomy with negative findings. The conventional course of treatment for pneumoperitoneum was followed, but was it necessary? Though the presentation of pneumoperitoneum is most often associated with significant pathology requiring surgical intervention, a more conservative approach may be applicable in cases similar to the one presented here.
Collapse
Affiliation(s)
- Mohammad Alassaf
- Gold Coast University Hospital, Department of Surgery, 1 Hospital Boulevard, Southport, QLD 4215, Australia.
| |
Collapse
|