Airway management: induced tension pneumoperitoneum

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.

Pneumoperitoneum in a COVID-19 Patient Due to the Macklin Effect

“…The thoracic origin of pneumoperitoneum is mostly associated with mechanical ventilation; nonetheless, with the novel COVID-19 pandemic, this radiological finding might present in some patients, especially with high-pressure management, along with the fact that many doctors with little expertise in the management of mechanical ventilation devices are nowadays treating these patients. Therefore, in the context of a patient with no abdominal manifestations and no inflammatory response, the non-surgical causes of pneumoperitoneum should be considered [ 3 , 4 ].…”

Gastric Perforation with Omental Patch Repair: A Rare Complication of Pulmonary Resuscitation in COVID-19 Pneumonia

“…Pneumoperitoneum (PP) from an intrathoracic route is the most commonly reported cause in nonsurgical intra-abdominal air collection, with an estimated incidence of approximately 7% in ICU patients [ 4 ]. In mechanically ventilated patients, PP has been strongly associated with pneumothorax and pneumomediastinum, likely from ruptured alveoli adjacent to the mediastinum or diaphragmatic dissection [ 4 , 5 ]. However, PP should be considered in mechanically ventilated patients with underlying lung disease and frequent ventilator setting changes.…”

“…The diagnostic algorithm of determining the source of PP is likely related to the chronological relationship between the likeliest procedure of cause and its incidence [ 5 ]. In our case, the PP onset shortly after reendotracheal intubation and BMV is very suggestive.…”

“…However, the occurrence of gastric perforation with BMV has been rarely reported [ 4 ]. COVID-19 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [ 5 , 6 ]. With the emergence of the novel COVID-19, the association with gastric pathology is unclear.…”

Tension pneumoperitoneum: Case report of a rare form of acute abdominal compartment syndrome

“…The etiology of this condition is divided into two categories: the surgical pneumoperitoneum due to a perforation of a hollow organ (80–90% of cases), and the nonsurgical or spontaneous pneumoperitoneum (10–20% of cases), with ventilator induced barotrauma as the leading underlying condition [1]. The former, generally, requires prompt surgical exploration and intervention [2], while the latter is associated with therapeutic dilemma. Additionally, in the medical literature, tension pneumoperitoneum denotes an extreme form of pneumoperitoneum in which the elevated intra-abdominal pressure (IAP) causes hemodynamic instability and respiratory failure [3,4].…”