Pneumoperitoneum without Perforation of the Gastrointestinal Tract

Abstract

Pneumoperitoneum (PP) is usually the result of perforation of the gastrointestinal (GI) tract with associated peritonitis. However, other rare causes, including spontaneous PP incidental to intrathoracic, intra-abdominal, gynecologic, and miscellaneous other origins not associated with a perforated GI tract have been described in the literature. Six cases of PP without any perforated GI tract are reported. Three patients with generalized peritonitis underwent exploratory laparotomy or laparoscopy when clinical examinations suggested an acute abdomen. At surgical procedure, perforated pyometra, perforated liver abscess and a ruptured necrotic lesion of a liver metastasis were documented in these patients, respectively. We also saw 3 PP patients not associated with peritonitis. Two patients with PP caused by pneumatosis cystoides intestinalis were encountered, 1 was managed conservatively and the other received diagnostic laparoscopy. A patient in whom pneumomediastinum and pneumoretroperitoneum were accompanied by PP caused by an alveolar rupture based on decreased pulmonary compliance due to malnutrition was managed conservatively. The history of the patient and knowledge of the less frequent causes of PP can possibly contribute towards refraining from exploratory laparotomy in the absence of peritonitis.

Spontaneous Uterine Perforation Due to Pyometra Presenting as Acute Abdomen

“…[4] In conclusion the diagnosis of spontaneous perforation of pyometra is rarely made preoperatively and the possibility of a perforated pyometra should therefore be considered when elderly women suffer from acute abdominal pain. Their management often difficult and hysterectomy and bilateral salpingo-oopherectomy may be the best choice procedure in these patients [5].…”

Spontaneous perforation of pyometra: A rare cause of diffuse peritonitis

“…Indeed, a review indicates that pneumoperitoneum is seen only 56% of cases of hollow viscus perforation. 8 CECT scan and/or MRI scan was not done in our case as she had presented with generalised peritonitis and thus merited an immediate exploratory laparotomy. In most cases reported earlier, spontaneously perforated pyometra is a diagnosis made intra-operatively when the original clinical diagnosis had been gastrointestinal perforation.…”

Spontaneous Rupture of Pyometra – A Rare Cause of Peritonitis In Elderly Female

“…Only less than 25 cases have been reported in English [5]. Pneumoperitoneum which was associated with a perforated pyometra was recognized only in 56% of cases.…”