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At least 19 recordsLinked to original sources

PubMed1975

Recurrent pneumoperitoneum due to jejunal diverticulosis. With a review of the causes of spontaneous pneumoperitoneum.

In the absence of abdominal operative procedures, symptomless spontaneous pneumoperitoneum is uncommon. The case is described of a patient with jejunal diverticulosis who developed spontaneous pneumoperitoneum on three occasions and brief details are given of six other cases of jejunal diverticulosis with pneumoperitoneum from the literature. Other causes of symptomless pneumoperitoneum include pneumatosis intestinalis, perforation in tabes dorsalis or coma, stercoral ulceration, physiological pneumoperitoneum in women due to exercise in the knee-elbow position, and vaginal douches with a bulb syringe or effervescent fluid.

Aged↗

PubMed1992

Effectors of hypercarbia during experimental pneumoperitoneum.

Hypercarbia occurs during laparoscopy with carbon dioxide (CO2) insufflation. This may be due to increased ventilatory dead space after expansion of the peritoneal cavity with impairment of diaphragmatic excursion, or to increased absorption of CO2 from the peritoneum. To separate these effects, the authors examined the consequences of different insufflating gases and of diminished tissue perfusion on hypercarbia and dead space during pneumoperitoneum. Helium was chosen as an alternate insufflating gas because it is both inert and minimally absorbed. Eight swine (18 to 20 kg) were anesthetized, paralyzed, and mechanically ventilated at constant minute volume. Pneumoperitoneum with helium was maintained at 15 mm Hg for 45 minutes. After desufflation and stabilization for 1 hour, pneumoperitoneum was repeated with CO2. The sequence was again repeated after hemorrhagic shock to constant mean arterial pressure of 50 mm Hg. Data was analyzed by analysis of variance; significance levels are P < 0.01 unless otherwise listed. Arterial PCO2 increased significantly with CO2 insufflation within 15 minutes in normotensive animals and within 30 minutes during hypotension. Arterial pH decrease with CO2 pneumoperitoneum was significant in both groups at 30 minutes. Mixed venous PCO2 also increased with CO2 pneumoperitoneum within 30 minutes. Hypotension did not alter these changes. No significant changes were seen with helium pneumoperitoneum. Neither helium nor CO2 pneumoperitoneum significantly altered dead space. The authors make the following conclusions: 1) Absorption of CO2 from the abdomen during CO2 pneumoperitoneum produces respiratory acidosis, which is not seen with helium insufflation; 2) Pneumoperitoneum does not significantly increase dead space with either gas; 3) Transperitoneal absorption of CO2 is only partly related to perfusion because significant hypercarbia occurs during hemorrhagic shock.

Absorption↗

PubMed1992

Hypercarbia during carbon dioxide pneumoperitoneum.

Patients with cardiopulmonary insufficiency undergoing laparoscopic surgery with carbon dioxide (CO2) pneumoperitoneum may retain CO2 resulting in clinically significant respiratory acidosis. A canine model of pulmonary emphysema induced by papain inhalation was utilized to evaluate the respiratory effects of both CO2 and helium pneumoperitoneum. Prior to papain inhalation and 5 and 8 weeks after initial treatment under general anesthesia, mechanical ventilation was adjusted to maintain the end-tidal CO2 (ETCO2) at 40 mm Hg during baseline and pneumoperitoneum physiologic monitoring periods. Utilizing an analysis of variance, hemodynamic and respiratory physiologic parameters were compared. In this canine model, all dogs demonstrated consistent hypercarbia during CO2 pneumoperitoneum prior to papain treatments, but CO2 retention was significantly increased in the emphysematous state. The occurrence of hypercarbia during CO2 pneumoperitoneum may be underestimated by ETCO2 monitoring as was revealed by an increased PaCO2 (arterial carbon dioxide pressure)-ETCO2 gradient with an increasing time interval between papain exposure and period of physiologic monitoring. Irrespective of the pulmonary condition of the dog, helium pneumoperitoneum did not produce any hypercarbic or acidic changes when compared with the concomitant baseline period of dogs prior to the induction of pneumoperitoneum, thus suggesting that helium pneumoperitoneum may be a reasonable alternative in patients at risk for CO2 retention.

Acidosis, Respiratory↗

PubMed1978

Postoperative pneumoperitoneum: an unusual etiology.

Although postoperative pneumoperitoneum is a common finding, it is particularly disturbing when there is an increase in the amount of postoperative pneumoperitoneum or when the radiographic finding of pneumoperitoneum is accompanied by such physical findings as increased abdominal tenderness, peritoneal signs or paralytic ileus. Four patients operated upon at the Mount Sinai Hospital are presented. All patients underwent abdominal surgery for treatment of some form of inflammatory bowel disease and all were receiving systemic corticosteroids in the postoperative period. Abdominal findings of tenderness, ileus and peritoneal irritation developed shortly after the removal of Penrose drains in the postoperative period. Pneumoperitoneum was confirmed by abdominal roentgenographs. The first patient in this group underwent a laparotomy with essentially negative findings other than a freely open drain tract. The subsequent three patients were managed by close observation and frequent abdominal radiographs. These three patients had contrast roentgenographic studies of the upper gastrointestinal tract to rule out perforation of a peptic ulcer, and in the patient upon whom reservoir ileostomy had been performed, a contrast study of the reservoir was performed. All patients recovered fully with this management and there were no sequelae. The mechanism for the appearance of pneumoperitoneum after removal of drains, particularly when the patient is receiving systemic corticosteroids, is discussed. Emphasis is placed on the need to consider and rule out perforation of a hollow viscus in this situation before accepting drain removal as the sole cause of post-operative pneumoperitoneum.

Abdomen↗

PubMedDate not supplied

Pneumoperitoneum following percutaneous endoscopic gastrostomy. Does the timing of panendoscopy matter?

Percutaneous endoscopic gastrostomy (PEG) has had a significant impact on enteral alimentation in patients unable to maintain adequate oral caloric intake. PEG avoids the morbidity and mortality associated with the traditional feeding gastrostomies placed by celiotomy. Several authors have documented benign, self-limiting pneumoperitoneum following PEG placement. No study has addressed whether the timing of panendoscopy in relation to gastric puncture has an effect on the incidence of post-PEG pneumoperitoneum. The authors prospectively studied 30 patients undergoing PEG. Panendoscopy was either performed before or after gastric puncture, and each patient then had abdominal radiographs to determine the presence of pneumoperitoneum. Four of 16 patients (25%) having panendoscopy prior to gastric puncture had radiographic evidence of pneumoperitoneum compared to three of 14 patients (23%) having panendoscopy following gastric puncture. The authors conclude that the timing of panendoscopy in relation to gastric puncture does not significantly effect the incidence of post-PEG pneumoperitoneum.

Aged↗

PubMed1977

Misleading pneumoperitoneum.

Misleading pneumoperitoneum takes one of two forms: true pneymoperitoneum without peritonitis or pneumoperitoneum simulated by adventitious x-ray shadows. In both instances, the roentgenographic appearance of free intraperitoneal air proves to be a specious indication for laparotomy. Twenty-eight per cent of 29 patients with misleading pneumoperitoneum were subjected to operations that, retrospectively, might not seem absolutely necessary. The decisions to operate on patients with pneumoperitoneum without peritonitis were based on the amount of pneumoperitoneum roentgenographically visualized. The instances of pseudopneumoperitoneum had several common features. The diagnosis often was based only on x-ray films of the chest. Compatibility with clinical features was marginal; the radiolucency was often not truly at the apex of the diaphragm. Finally, the x-ray films, interpretation and working conditions frequently were suboptimal.

Adolescent↗

PubMed1977

[Pneumoperitoneum of genital origin. Apropos of a case at the beginning of pregnancy].

The authors studied the literature for similar findings in order to try to classify the different types of pneumoperitoneum when they had a case of pneumoperitoneum of genital origin. They then went on to study the mechanism by which these rare cases of genital pneumoperitoneum occurred: the insufflation or aspiration of air through the tubes, tubal antiperistalsis and uterine or vaginal perforations. From the clinical angle it is essential to eliminate pneumoperitoneum secondary to perforation of a hollow organ, and then to look for signs of peritonitis which only occur in genital pneumoperitoneum due to uterine perforation. The case usually cures spontaneously but recurrences are not uncommon. If there are no signs of peritonitis expectant treatment should usually be undertaken.

Abortion, Induced↗

PubMed1979

Pneumoperitoneum associated with pneumothorax or pneumopericardium: a surgical dilemma in the injured patient.

Three cases of 'idiopathic pneumoperitoneum' following injury are reviewed. Two cases occurred several days after initial injury and were associated with post-traumatic pneumothorax and artificial respiration. It is likely that artificial respiration induced pneumoperitoneum in these cases. The third case of pneumoperitoneum occurred one hour after initial injury and was associated with bilateral pneumothoraces and pneumopericardium. Congenital abnormalities and tension pneumothorax were thought to account for this case of 'idiopathic pneumoperitoneum'.

Adolescent↗

PubMed1992

[Computed tomographic assessment of breathing-induced "pseudo" pneumoperitoneum].

The differentiation between a "pseudo" pneumoperitoneum and a pneumoperitoneum due to a perforation may be difficult in unconscious or ventilated patients. The use of CT for differentiating between extraperitoneal and intraperitoneal air is demonstrated by three examples in whom air below the diaphragm was shown by conventional radiographs. CT can prove the extraperitoneal position of an air crescent below the diaphragm in cases of "pseudo" pneumoperitoneum. CT will also show that extraperitoneal air does not rise in the way that true peritoneal air will do when the patient is supine. In this position the viscera therefore do not fall backwards in the presence of a "pseudo" pneumoperitoneum.

Adult↗

PubMedDate not supplied

Spontaneous pneumoperitoneum without peritonitis.

Spontaneous pneumoperitoneum without peritonitis is a rare phenomenon which poses a dilemma to the surgeon faced with this problem. Two such cases and their outcome are presented. The first case was caused by barotrauma during positive pressure ventilation and was treated by laparotomy. No perforated viscus was found. The second case was caused by tracheal rupture during emergency intubation and was treated by observation until complete resolution. Both patients died for reasons unrelated to the pneumoperitoneum. The mechanisms for passage of air from the chest into the abdominal cavity were through the diaphragm in the first case and along the great vessels in the second. A compilation of other etiologies of pneumoperitoneum without peritonitis as extracted from the literature is presented. In the presence of pneumoperitoneum without peritonitis and when the clinical history does not suggest perforation of a viscus, we advise performing an abdominal tap. If negative, continued observation is advised.

Aged↗

PubMed1992

[Monosymptomatic pneumoperitoneum is not an indication for surgery].

UNLABELLED: Pneumoperitoneum results from a perforation of the gastrointestinal tract in the majority of instances and the necessity for surgery is involved. In some cases with monosymptomatic pneumoperitoneum, surgery is unnecessary. A case of a man aged 64 with great amount of free intraperitoneal air is presented. The patient was clinically unaffected and had neither fever nor signs of peritoneal affection. The intraperitoneal air decreased slowly and disappeared after about 60 days. A self-sealing perforation of a duodenal ulcer was the cause of pneumoperitoneum. The most common causes of non-surgical pneumoperitoneum (PP) are discussed. IN CONCLUSION: Monosymptomatic PP is not an indication for emergency surgery. If the patient has no signs of peritoneal reactions conservative treatment can be considered.

Humans↗

PubMed1992

[Pneumoperitoneum in a premature, non-ventilated neonate with respiratory distress syndrome leading to respiratory failure. What is the etiology?].

The authors describe the finding of extensive tensive pneumoperitoneum which developed during distension therapy (CNP) in an immature neonate. The absence of another extraalveolar cumulation of air made the authors use PO2 analysis in the peritoneal air by means of a transcutaneous electrode. Because the PO2 rose after connection of the electrode to the catheter draining the abdominal cavity, the authors assumed a respiratory aetiology of the pneumoperitoneum and did not consider laparatomy. They assume that the above test may be valuable in the differential diagnosis between respiratory and gastrointestinal pneumoperitoneum in those instances where it is not possible to assess the aetiology of pneumoperitoneum unequivocally.

Humans↗

PubMed1979

Jejunal diverticulosis and chronic pneumoperitoneum.

A unique case of pneumoperitoneum, without peritonitis or perforation, associated with jejunal diverticulosis is presented. Pneumoperitoneum is documented over the course of many years, with recurrence after partial small bowel resection. Jejunal diverticulosis is one of the leading gastrointestinal causes of pneumoperitoneum without peritonitis or surgery. The distended diverticular mucosa may function as a semipermeable membrane allowing transmural gas equilibration.

Aged↗

PubMed1978

Benign pneumoperitoneum following median sternotomy incision.

Because of the close anatomic relationship of the pericardium, diaphragm, and peritoneal cavity, a benign pneumoperitoneum may occur following median sternotomy incision and cardiac surgery. The pneumoperitoneum results from inadvertent opening of the peritoneal cavity during the initial surgical incision or during the subsequent cardiac surgery. It is generally of no significance to the patient, although it must be distinguished from pneumoperitoneum occuring secondary to intraabdominal pathology or to retrograde dissection of extraalveolar air in patients on ventilatory support. Two illustrative cases are presented.

Aged↗

PubMed1977

Pneumoperitoneum without clinical peritonitis due to bilateral pyosalpinx.

A case of pneumoperitoneum without clinical peritonitis due to bilateral pyosalpinx is presented. This clinical condition has in the literature been called "spontaneous or idiopathic pneumoperitoneum", and conservative treatment in such cases has been advocated. As shown in our case severe intraperitoneal pathology may exist, and we therefore advocate early explorative laparotomy in all patients with pneumoperitoneum without peritonitis.

Aged↗

PubMed1977

Pneumoperitoneum associated with pneumothorax: a surgical dilemma in the post-traumatic patient.

Two patients with pneumoperitoneum associated with post-traumatic pneumothorax are described. The role of artificial respiration in the production of pneumoperitoneum is descussed. This association presents a curious diagnostic dilemma. If the diagnosis of perforated hollow viscus can be eliminated with considerable certainty, then conservative management with careful observation and monitoring may avoid unnecessary surgery, so long as other causes of pneumoperitoneum have been ruled out.

Adult↗

PubMed1978

Direct laparoscope trocar insertion without prior pneumoperitoneum.

The results of direct trocar insertion without prior establishment of pneumoperitoneum are documented in 301 consecutive laparoscopies. No complications or technical failures attributable to the method were encountered. A reduction of complications associated with needle-induced pneumoperitoneum may be possible with this method.

Female↗

PubMed1979

Pneumoperitoneum and pneumoretroperitoneum. Consequences of positive end-expiratory pressure therapy.

Patients receiving positive end-expiratory pressure (PEEP) therapy should be considered at risk for pneumoperitoneum. In the four patients described, chest roentgenographic demonstration of pulmonary interstitial gas and pneumomediastinum, frequently but not always associated with pneumothorax, preceded the dissection of gas into the abdominal cavity. Neither prompt intubation of the pleural space with reexpansion of the lung in the event of pneumothorax nor decrease in the PEEP applied precluded dissection of gas from the mediastinum into the retroperitoneal and peritoneal spaces. This sequence of roentgenographic events should strongly suggest pneumoretroperitoneum and pneumoperitoneum as a sequela to PEEP therapy rather than a ruptured viscus.

Adult↗