Does pneumoperitoneum always require laparotomy? Report of six cases and review of the literature

Karaman, Abdurrahman; Demirbilek, Semra; Akın, Melih; Gürünlüoğlu, Kubilay; İrşi, Cesim

doi:10.1007/s00383-005-1569-4

Cited by 10 publications

(22 citation statements)

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“…Three hundred thirty-eight patients were examined in our clinic because of abdominal pain or if free air was determined in imaging methods. Patients with underlying surgical or non-surgical etiologies for pneumoperitoneum were excluded from the study (4,5). The excluded etiologic factors of spontaneous pneumoperitoneum are shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

The rate of idiopathic spontaneous pneumoperitoneum is 2.36%

Peker¹,

Çikot²,

Bozkurt³

et al. 2017

Bakirkoy

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Araştırmalar / Researches ÖZET İdiopatic spontan pnömoperitoneumun sıklığı: 2.36% Amaç: Pnömoperitoneum genellikle viseral perforasyonu takiben, peritonit ile birlikte görülmekte ve acil cerrahi girşim gerektirir. Cerrahi bir sebebe bağlı olmayan spontan pnömoperiton (organ perforasyonuna bağlı gelişmeyen), intratorasik, intraabdominal, jinekolojik, iyatrojenik ya da diğer sebeplere bağlı olarak görülen nadir bir durumdur ve konsevatif olarak tedavi edilmelidir. Spontan idiyopatik pnömoperiton bir viseral perforasyona bağlı olmayabilir, ekstraabdominal olabilir ve sebep tespit edilemeyebilir. Biz bu çalışmamızda herhangi bir visceral organa bağlı olmayan serbest havası olan hastaların bulgularını retrospektif incelemeyi amaçladık. Gereç ve Yöntem: Bu retrospektif çalışma kliniğimize görüntülemelerinde karın içi serbest hava saptanan karın ağrısı ile başvuran 338 hastanın incelenmesi ile oluşturulmuştur. Pnömoperiton sebebi cerrahiye bağlı olan hastalar çalışmadan çıkarılmıştır. Karın ağrısı olan hastalar akut karın bulguları olup olmamasına bağlı olarak iki gruba ayrılmıştır. Akut karın bulgusu olmayan hastalar en az 48-72 saat gözlem altında tutulmuştur. Akut karın bulgusu olan hastalara lökosit ve c-reaktif protein (CRP) düzeylerine göre diagnostik laparoskopi uygulanmıştır. Bu hastalar diagnostik laparoskopi veya laparotomide adım adım izlenen bir protokol ile etyoloji aranarak incelenmiştir. Bulgular: 338 hastanın 8 tanesi (2.36%) idiyopatik spontan pnömoperiton tanısı almıştır. Dört hasta (1.18%) cerrahiye bağlı olmayan, dört hasta (1.18%) ise cerrahiye bağlı pnömoperiton olarak değerlendirilmiştir. Tartışma: Cerrahi girişim spontan pnömoperiton ve akut karın bulguları olması durumunda kaçınılmazdır. Buna rağmen herhangi bir inflamatuar oluşum gözlenmeyebilir. Cerrahi girişim adım adım protokolüne uygun olarak uygulanmalıdır.

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Section: Resultsmentioning

confidence: 99%

The rate of idiopathic spontaneous pneumoperitoneum is 2.36%

Peker¹,

Çikot²,

Bozkurt³

et al. 2017

Bakirkoy

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“…En realidad, los signos radiológicos eran mucho más preocupantes que los exploratorios y esa incongruencia fue la que nos decidió a posponer una intervención. Estábamos convencidos que el resultado de la exploración quirúrgica se-ría negativo, como ha sido publicado por otros autores 1,3,5,6 , a pesar de que la sintomatología principal fuese abdominal y que hubiesen unos antecedentes de cirugía intestinal previa.…”

Section: Discussionunclassified

“…El 90% de los neumoperitoneos tienen una causa quirúrgica 5 . Distinguir aquéllos en los que se podría evitar una laparotomía exploradora es muy difícil.…”

Section: Discussionunclassified

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An infant with intestinal pneumatosis and pneumoperitoneum: the difficult decision not to intervene

Pisón-Chacón

Pérez‐Martínez

García

et al. 2018

An Sist Sanit Navar

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Pneumoperitoneum in children may be due to causes that do not require urgent surgery (cardiopulmonary resuscitation manoeuvres, severe respiratory pathology or mechanical ventilation). Surgery in these cases could even worsen the prognosis. We present the case of a male infant, ex-preterm, with a history of necrotizing enterocolitis and ileal perforation at birth, requiring laparotomy and intestinal resection on two occasions and developing a secondary microcolon, due to disuse. At six months, after transitioning to full oral feeding, he presented abdominal distension with extensive intestinal pneumatosis and pneumoperitoneum on radiographs. His general appearance was good with normal intestinal transit and no peritonitis. The patient remained fasting with intravenous antibiotics, nasogastric decompression and parenteral nutrition. The evolution was favourable with oral feeding restarting on the seventh day of admission. The existence of pneumoperitoneum does not always require a laparotomy and global assessment of the patient by an interdisciplinary health team may avoid unnecessary aggressive treatments.

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“…Although non‐surgical pneumoperitoneum only accounts for 10% of cases, this is still a significant number of patients in whom laparotomy is not indicated. The literature reports many patients with nonsurgical pneumoperitoneum who underwent exploratory laparotomy during which no intra‐abdominal pathology was found 4 …”

Section: Discussionmentioning

confidence: 99%

Spontaneous pneumoperitoneum: Diagnostic and management difficulties

Mann¹,

Bhati²,

Gemmell³

et al. 2010

Emerg Medicine Australasia

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Acute abdominal pain is a common presentation to the ED. Most patients undergo a chest radiograph as part of their initial investigations, which occasionally reveals pneumoperitoneum. Pneumoperitoneum on imaging suggests a perforated hollow abdominal viscus and therefore often constitutes a surgical emergency. However, if the patient is neither peritonitic nor septic a management dilemma is faced. Some cases of pneumoperitoneum might be managed conservatively thus avoiding unnecessary laparotomy. We present a case of recurrent spontaneous pneumoperitoneum with abdominal pain that was managed conservatively and discuss the possible aetiologies and management issues of spontaneous pneumoperitoneum.

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Does pneumoperitoneum always require laparotomy? Report of six cases and review of the literature

Abstract: This article was mistakenly published as a Case Report. In fact, it is an Original Article.

Cited by 10 publications

References 0 publications

The rate of idiopathic spontaneous pneumoperitoneum is 2.36%

The rate of idiopathic spontaneous pneumoperitoneum is 2.36%

An infant with intestinal pneumatosis and pneumoperitoneum: the difficult decision not to intervene

Spontaneous pneumoperitoneum: Diagnostic and management difficulties

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