Spontaneous aseptic pneumoperitoneum

Abstract

Pneumoperitoneum indicates the need for urgent laparotomy. But under certain clinical situations like, patient on ventilatory support should arouse the suspicion of supradiaphragmatic source of pneumoperitoneum. Supradiaphragmatic causes account for 10%. This article describes two patients, both on ventilatory support in the intensive care unit. Failure to recognize spontaneous aseptic-pneumoperitoneum can result in unnecessary laparotomy with its risks. Hence under relevant circumstances, non-surgical causes of pneumopreitoneum should be excluded.

Two similar cases of elderly women with moderate abdominal pain and pneumoperitoneum of unknown origin: a surgeon's successful conservative management

“…Sedated and artificially ventilated patients, especially, represent a higher risk group. Pneumoperitoneum of unknown origin often leads to an explorative surgery in the intensive care unit setting 26. Gynaecological causes for pneumoperitoneum, such as sexual intercourse after hysterectomy or exercises postpartum, also exist 27 28…”

Nonsurgical pneumoperitoneum in a dog secondary to blunt force trauma to the chest

“…Two potential mechanisms for the passage of air from the thoracic to the abdominal cavity have been proposed in human reports: (1) the direct passage of air through pleural and diaphragmatic defects, natural microscopic fenestrations, or the epiploic foramen, and (2) the indirect passage of air, via the mediastinum, along perivascular sheaths or major diaphragmatic portals, such as the aortic and esophageal hiatus, to the retroperitoneum and finally into the peritoneum . When the bronchioles, alveolar ducts, and alveoli are overdistended by an increase in intrathoracic pressure, air collections leak into the perivascular tissues, which then migrate along a path of least resistance .…”

“…The human literature has placed the etiology of nonsurgical pneumoperitoneum into 5 categories: thoracic, intraabdominal, gynecological, iatrogenic, and miscellaneous . Thoracic causes of nonsurgical pneumoperitoneum in people have been associated with cardiopulmonary resuscitation (CPR), intermittent positive‐pressure ventilation, barotrauma, pneumothorax, increased intrathoracic pressure, asthma, blunt trauma, spontaneous rupture of pulmonary blebs, and severe pulmonary disease . Abdominal pressure usually exceeds intrathoracic pressure by 20–30 cm H 2 O during both inspiration and expiration in people.…”