The Pattern of Causes of Pneumoperitoneum-induced Peritonitis: Results of an Empirical Study

Abstract

Pneumoperitoneum refers to presence of free air within the peritoneal cavity, “Pneumoperitoneum induced Peritonitis” is synonymous of surgical pneumoperitoneum, as the leak of air and visceral contents contaminates the peritoneal cavity, producing peritonitis which mandates surgery. This entire pneumoperitoneum may result from inflammatory conditions, traumatic injury, neoplasia, anastomotic leak and vascular causes.The objectives of this study is to determine the incidence of Pneumoperitoneum-induced Peritonitis (surgical pneumoperitoneum) in emergency exploratory laparotomies, to identify the common anatomical sites of perforations and to review the pathological etiology of these cases.Review of 450 cases of emergency exploratory laparotomy cases performed in King Abdulaziz University Hospital from January 2011 to December 2015, among them 131 cases with radiologically documented pneumoperitoneum were selected to be involved in the study of surgical pneumoperitoneum, the anatomical site of perforation and the exact underlying pathology were documented.29% of exploratory laparotomy cases were found to have pneumoperitoneum, mainly in the in the gastroduodenal region, inflammatory conditions as peptic ulcer disease or diverticulitis were the underlying cause of most of perforations.Pneumoperitoneum frequently indicates bowel injury or disease, hence it is called surgical pneumoperitoneum, Perforations are commonly found in gastro-duodenal area, the inflammatory conditions are responsible for the vast majority of cases, however presence of air with intact bowel, is called Non-Surgical or spontaneous Pneumoperitoneum, which has to be approached conservatively.

Tardive peritonitis after the endoscopic ultrasound‐guided hepaticogastorostomy: A case report

“…These are only predictions because the blood culture at the time of peritonitis onset was negative but considering that the positivity rate of blood culture in biliary tract infections is only approximately 5%, 8 the estimation from the imaging findings is reasonable. Moreover, the previous report accessing the cause of peritonitis induced by the air leakage, which showed that air leakage of postoperative status, was the third common cause of the peritonitis, and the most common anatomical site of air leakage was gastroduodenal legion might support our opinion 9 …”

“…Moreover, the previous report accessing the cause of peritonitis induced by the air leakage, which showed that air leakage of postoperative status, was the third common cause of the peritonitis, and the most common anatomical site of air leakage was gastroduodenal legion might support our opinion. 9 …”

“…Moreover, the previous report accessing the cause of peritonitis induced by the air leakage, which showed that air leakage of postoperative status, was the third common cause of the peritonitis, and the most common anatomical site of air leakage was gastroduodenal legion might support our opinion. 9 A fully covered SEMS (FCSEMS) is often used for EUS-HGS to ensure patency and reduce bile leakage from the fistula between the stomach and hepatic duct. 2,10 In recent years, SEMS with only the distal end uncovered to avoid obstruction of the bile duct and stents with a small diameter to match the bile duct diameter have been introduced.…”

Acute perforated appendicitis in adults: Management and complications in Lagos, Nigeria

“…[2021] Some larger retrospective studies have reported findings of pneumoperitoneum in 5%–8% of gastrointestinal perforations due to perforated appendicitis. [2223] In 23 patients evaluated with abdominal/chest X-ray, we found the frequency of pneumoperitoneum in 3 (13%) cases. A higher value obtained in this study may be attributed to the estimation of frequency of pneumoperitoneum in cohorts of patients under review, rather than the etiology of pneumoperitoneum in acute abdomen which was evaluated in most studies.…”

“…A higher value obtained in this study may be attributed to the estimation of frequency of pneumoperitoneum in cohorts of patients under review, rather than the etiology of pneumoperitoneum in acute abdomen which was evaluated in most studies. [2223] The clinical diagnosis and indications for surgery in most of our patients were based mainly on the history and clinical signs of peritonitis. Positive radiological signs of perforation such as pneumoperitoneum were added reinforcement to our diagnosis and our decision to operate.…”