Tension Pneumoperitoneum from Tracheal Tear During Pharyngolaryngoesophagectomy

Lal, Adarsh B.; Kumar, Naresh; Sami, Khalid A.

doi:10.1213/00000539-199502000-00034

Cited by 7 publications

(6 citation statements)

References 11 publications

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“…Radiographically, massive accumulation of intraperitoneal gas, an elevated diaphragm with cardiac compression, and centralization of abdominal organs has been observed [2]. Although cardiorespiratory embarrassments are potentially fatal, rapid improvements after abdominal decompression have been reported [2,4,11,13]. These clinical or radiographic appearances were mostly consistent with those seen in the cat documented in this report.…”

supporting

confidence: 77%

“…67(6): 617-619, 2005 Pneumoperitoneum refers to the presence of gas within the peritoneal cavity resulting from a ruptured hollow viscus, penetrating abdominal wounds or bacterial peritonitis [1]. Life-threatening, massive pneumoperitoneum necessitating immediate needle decompression to improve cardior e s p i r a t o r y e m b a r r a s s m e n t , k n o w n a s t e n s i o n pneumoperitoneum, has been reported in humans [2,4,11,13]. However, few reports have documented similar cases in veterinary fields.…”

mentioning

confidence: 99%

“…Forceful ventilation is often associated with the progression of gas accumulation [4,11,13]. Tension pneumoperitoneum is characterized by acute, tympanic abdominal distention and respiratory or circulatory embarrassments resulting from elevated abdominal pressure [2,4,11,13].…”

mentioning

confidence: 99%

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Tension Pneumoperitoneum Due to Gastric Perforation in a Cat

Itoh¹,

Nibe²,

Naganobu

2005

The Journal of Veterinary Medical Science

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ABSTRACT. A 14-year-old spayed female cat weighing 2.3 kg developed tension pneumoperitoneum that progressed for 6 hr. Abdominocentesis was performed and 1.3 L of gas was aspirated after which the cat's respiratory condition improved. The next day, the cat's abdomen redistended, and laparotomy was performed. A gastric perforation was noted and sutured after the margin was resection. The cat showed a good physical condition without any gastrointestinal signs at 6 months after surgery. KEY WORDS: feline, gastric perforation, tension pneumoperitoneum.J. Vet. Med. Sci. 67(6): 617-619, 2005 Pneumoperitoneum refers to the presence of gas within the peritoneal cavity resulting from a ruptured hollow viscus, penetrating abdominal wounds or bacterial peritonitis [1]. Life-threatening, massive pneumoperitoneum necessitating immediate needle decompression to improve cardior e s p i r a t o r y e m b a r r a s s m e n t , k n o w n a s t e n s i o n pneumoperitoneum, has been reported in humans [2,4,11,13]. However, few reports have documented similar cases in veterinary fields. This study reports the case of a cat that developed tension pneumoperitoneum secondary to gastric perforation and was treated with abdominocentesis followed by laparotomy.A 14-year-old spayed female, domestic shorthair cat weighing 2.3 kg presented with marked abdominal distension that had been progressing for 6 hr. For 1 week prior to admission, the cat had been anorexic after a transient episode of vomiting. The owner described 6 episodes of vomiting during a 4-month prior to admission, which had always been resolved with symptomatic therapy for gastritis. The cat had also been affected with chronic rhinitis for several years.At the time of admission, the cat was collapsed in a recumbent position and was tachypneic with ballooned, tympanic abdominal distension. Heart rate was 180 beats per minute, and rectal temperature was 34.2°C. The mucus membrane was pale and purulent nasal discharge was noticed. Abdominal radiography revealed massive pneumoperitoneum with cranial displacement of the diaphragm, centralization of the abdominal organs, and a small amount of air within the contracted stomach (Fig. 1). Initial hematological abnormalities included a mildly low packed cell volume (32%), severe neutrophilia (42,240 cells/µL), and mild lymphopenia (880 cells/µL). Plasma biochemical analysis revealed high protein (9.6 g/dl), urea nitrogen (72 mg/dl), sodium (158 mEq/L) and chloride concentrations (121 mEq/L), and a low glucose concentration (63 mg/dl). The cat was seropositive for feline immunodeficiency virus antibody.Since abdominal radiographs suggested high intraabdominal pressure reducing diaphragmatic compliance, abdominocentesis was performed and 1.3 L of air was aspirated. The cat's respiratory condition returned to almost normal. After administration of 5% glucose (20 ml, IV), cefazolin sodium (20 mg/kg, SC), and enrofloxacin (5 mg/ kg, IM), the cat returned to the owner's care at home because it was late at night. The next morning, the cat...

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Tension Pneumoperitoneum Due to Gastric Perforation in a Cat

Itoh¹,

Nibe²,

Naganobu

2005

The Journal of Veterinary Medical Science

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“…TPP has been reported following bowel perforation, cardiopulmonary resuscitation, barotrauma, diaphragmatic injuries, and urologic procedures (Carey and Napoli, 2012; Lal et al., 1995). When caused by direct thoracic injury, two mechanisms for the transit of air from the thorax to the abdomen have been proposed.…”

Section: Discussionmentioning

confidence: 99%

Tension pneumoperitoneum caused by blunt thoracic trauma

Webman

Rosenzweig

Bholat

et al. 2013

Trauma

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Tension pneumoperitoneum is a rare entity that occurs when free air under pressure accumulates in the abdominal cavity compromising visceral function and blood flow. The case of a 23-year-old man whose chest was run over by the wheels of a truck is presented. He arrived with a severely distended abdomen, significant thoracic trauma, hypoxemia, and elevated airway pressures following intubation. Imaging studies revealed massive intraperitoneal free air. He was treated with a decompressive laparotomy but was not found to have a hollow viscus nor diaphragmatic injury. We hypothesize a possible, as yet unpublished, mechanism: secondary to the patient’s rib fractures and significant torso soft tissue shearing, a defect in the parietal pleura allowed air to track from the thorax inferiorly along subcutaneous and fascial planes, eventually entering into the peritoneal cavity through a violated parietal peritoneum. We present a review of the literature on tension pneumoperitoneum.

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“…If a neuromuscular blocker is used, positive pressure ventilation before isolation of the tracheal disruption may further aggravate the mediastinal emphysema and air leak. Once the level of tear has been determined, the algorithm recommends placing the endotracheal tube below the tear to avoid increasing the pneumomediastinum and subcutaneous emphysema with positive pressure ventilation [15,16]. If the tear is too low, close to the carina or involves one bronchus, a double lumen tube may be used.…”

Section: Anaesthetic Managementmentioning

confidence: 99%

Anaesthetic management of tracheal tear

Bansal¹,

Hooda²

2012

CMJ

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Tracheal tear is an uncommon but a serious injury that may be lethal because of the difficulties of accurate anatomical diagnosis and perioperative airway management. A high degree of suspicion is essential to identify these cases and early intervention is associated with better outcome. The anaesthesiologist managing such a case should be aware of the difficulties during securing the airway and during repair of trachea. Proper planning and keeping back up plans ready helps in successful management of these patients. The anaesthetic management needs to be modified during repair of the trachea by using total intravenous anaesthesia and insertion of an endotracheal tube in the trachea distal to the tear. Keywords: Tracheal tear, anaesthetic management, airway ÖzetTrakeal yırtık nadir ancak doğru anatomik tanımlama ve perioperatif havayolu yönetimindeki güçlükler nedeniyle ölümcül olabilecek kadar ciddi bir hasardır. Bu vakaların tanınmasında yüksek klinik şüphe gerekir ve erken müdahale ile tedavi sonuçları daha iyidir. Anestezist, havayolunun güvenliği ve trakeanın tamiri sırasındaki güçlüklerin farkında olarak bu tür hastaları tedavi etmelidir. Uygun planlama ve yedek planların oluşturulmasıyla bu tür hastalar başarılı bir şekilde tedavi edilebilirler. Trakeanın tamiri sırasında, total intravenöz anestezi uygulanıp yırtığın distalindeki trakeaya endotrakeal tüp yerleştirilirken anestezik tedavinin modifiye edilmesi gerekmektedir. Anahtar sözcükler: Trakeal yırtık, anestezik tedavi, havayoluGeliş tarihi

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Tension Pneumoperitoneum from Tracheal Tear During Pharyngolaryngoesophagectomy

Cited by 7 publications

References 11 publications

Tension Pneumoperitoneum Due to Gastric Perforation in a Cat

Tension Pneumoperitoneum Due to Gastric Perforation in a Cat

Tension pneumoperitoneum caused by blunt thoracic trauma

Anaesthetic management of tracheal tear

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