Klebsiella pneumonia with pneumothorax, pneumomediastinum and pneumoperitoneum

An Intriguing Case of Pneumoperitoneum In a Patient With COVID-19: Do All Pneumoperitoneum Cases Need Surgery?

Pneumoperitoneum is pneumatosis in the potential space of the abdominal cavity. It is generally considered a surgical emergency and is mostly due to perforated hollow viscus. Rarely, pneumoperitoneum might occur even in the absence of bowel perforation. We hereby present a case of pneumoperitoneum in a patient with COVID-19 pneumonia and pneumomediastinum, which was managed non-surgically.

Spontaneous pneumoperitoneum and other nonsurgical causes of intraperitoneal free gas

Intraperitoneal free gas seen radiologically as air under the diaphragm nearly always indicates a perforated abdominal viscus that requires surgical intervention. Rarely, however, the presence of a pneumoperitoneum may not indicate an intra-abdominal perforation and thus may not require laparotomy. Such a situation is termed spontaneous or nonsurgical pneumoperitoneum. In this review, we explore the aetiological mechanisms and the pathophysiology of the appearance of intra-abdominal free gas. An appreciation of the condition and its likely aetiological factors should improve awareness and possibly reduce the imperative to perform an emergency laparotomy on an otherwise well patient with an unexplained pneumoperitoneum.

Barotrauma related to inhalational drug abuse

Three patients are described who developed either pneumomediastinum or "clicking pneumothorax" after abusing illicit drugs. In recent years, patients presenting with pneumomediastinum after abusing cocaine have been frequently reported; these patients are most commonly young males with pleuritic chest pain. Seventy-three percent have detectable subcutaneous emphysema and fifty percent have a Hamman's sign. The pathophysiology, presenting features, and treatment of patients with barotrauma related to inhalational drug abuse are reviewed.

Empyema due to Klebsiella pneumoniae

Three cases of post-pneumonic empyema due to infection with Klebsiella pneumoniae are reported. All were men considerably debilitated by complicating factors. The presence of persistent fistulae and of lung necrosis makes eradication of this infection very difficult and tedious, and in the management of these cases the objective is to secure adequate removal of necrotic tissue, effective drainage, and finally a satisfactory deroofing procedure to obliterate the empyema cavity.