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Pneumoperitoneum

December 18, 2023

Pneumoperitoneum is pneumatosis (abnormal presence of air or other gas) in the peritoneal cavity, a potential space within the abdominal cavity. The most common cause is a perforated abdominal organ, generally from a perforated peptic ulcer, although any part of the bowel may perforate from a benign ulcer, tumor or abdominal trauma. A perforated appendix seldom causes a pneumoperitoneum.

Pneumoperitoneum
Frontal chest X-ray. The air bubble below the right hemidiaphragm (on the left of the image) is a pneumoperitoneum.
SpecialtyGastroenterology 

Spontaneous pneumoperitoneum is a rare case that is not caused by an abdominal organ rupture. This is also called an idiopathic spontaneous pneumoperitoneum when the cause is not known.

In the mid-twentieth century, an "artificial" pneumoperitoneum was sometimes intentionally administered as a treatment for a hiatal hernia. This was achieved by insufflating the abdomen with carbon dioxide. The practice is currently used by surgical teams in order to aid in performing laparoscopic surgery.

Causes edit

Spontaneous pneumoperitoneum edit

A spontaneous pneumoperitoneum is a rare case that is not caused by an abdominal organ rupture. This is also called an idiopathic spontaneous pneumoperitoneum when the cause is not known.[16] Causes of a spontaneous pneumoperitoneum, with no peritonitis include a barotrauma due to mechanical ventilation, and a tracheal rupture following an emergency intubation. In the ventilation case, air had passed from the chest into the abdominal cavity through the diaphragm. In the tracheal rupture air had passed along the great vessels.[17]

Diagnosis edit

When present, pneumoperitoneum can often be seen on projectional radiography, but small amounts are often missed, and CT scan is nowadays regarded as a criterion standard in the assessment of a pneumoperitoneum.[18] CT can visualize quantities as small as 5 cm³ of air or gas.

Signs that can be seen on projectional radiography are shown below:

The double wall sign marks the presence of air on both sides of the intestine.[19] However, a false double wall sign can result from two loops of bowel being in contact with one another.[20] The sign is named after Leo George Rigler.[21] It is not the same as Rigler's triad.

The football sign is when the abdomen appears as a large oval radiolucency reminiscent of an American football on a supine projectional radiograph.[22] The football sign is most frequently seen in infants with spontaneous or iatrogenic gastric perforation causing pneumoperitoneum. It is also seen in bowel obstruction with secondary perforation, as in Hirschprung disease, midgut volvulus, meconium ileus and intestinal atresia. Iatrogenic causes like endoscopic perforation may also give football sign.[citation needed]

The Cupola sign is seen when air is accumulated under the central tendon of the diaphragm.[23]

  •  
    Another pneumoperitoneum on chest X-ray.
  •  
    Pneumoperitoneum seen on X-ray with the patient lying on his left side.
  •  
    Double wall sign. This is a secondary sign of pneumoperitoneum. Patient is supine, and air within the abdomen and lumen of the bowel accentuate both sides of the bowel wall.
  • Ultrasound finding of pneumoperitoneum known as "peritoneal stripe sign"[24]

Differential diagnosis edit

As differential diagnoses, a subphrenic abscess, bowel interposed between diaphragm and liver (Chilaiditi syndrome), and linear atelectasis at the base of the lungs can simulate free air under the diaphragm on a chest X-ray.[citation needed]

Treatment edit

Treatment depends on the cause of the condition.[citation needed]

Terminology edit

Pneumoperitoneum can be described as peritoneal emphysema,[25] just as pneumomediastinum can be called mediastinal emphysema, but pneumoperitoneum is the usual name.

See also edit

References edit

  1. ^ "Peptic Ulcer Disease". The Lecturio Medical Concept Library. Retrieved 10 August 2021.
  2. ^ "Large Bowel Obstruction". The Lecturio Medical Concept Library. Retrieved 10 August 2021.
  3. ^ "Small Bowel Obstruction". The Lecturio Medical Concept Library. Retrieved 10 August 2021.
  4. ^ . Lexico Dictionaries | English. Archived from the original on July 17, 2019. Retrieved 2019-07-17.
  5. ^ Stewart MG (2005). "Principles of ballistics and penetrating trauma". In Stewart MG (ed.). Head, Face, and Neck Trauma: Comprehensive Management. Thieme. pp. 188–94. ISBN 3-13-140331-4. Retrieved 2008-06-12.
  6. ^ "Megacolon". The Lecturio Medical Concept Library. Retrieved 10 August 2021.
  7. ^ Necrotizing Enterocolitis Bugs, Drugs and Things That Go Bump in the Night
  8. ^ "Colon Cancer Treatment (PDQ®)". NCI. May 12, 2014. from the original on July 5, 2014. Retrieved June 29, 2014.
  9. ^ Higgins PD, Davis KJ, Laine L (April 2004). "Systematic review: the epidemiology of ischaemic colitis". Alimentary Pharmacology & Therapeutics. 19 (7): 729–38. doi:10.1111/j.1365-2036.2004.01903.x. hdl:2027.42/74164. PMID 15043513. S2CID 9575677.
  10. ^ Brandt LJ, Boley SJ (May 2000). "AGA technical review on intestinal ischemia. American Gastrointestinal Association". Gastroenterology. 118 (5): 954–68. doi:10.1016/S0016-5085(00)70183-1. PMID 10784596.
  11. ^ American Gastroenterological Association (May 2000). . Gastroenterology. 118 (5): 951–3. doi:10.1016/S0016-5085(00)70182-X. PMID 10784595. Archived from the original on 2007-09-27.
  12. ^ Imran M, Bhat R, Anijeet H (April 2011). "Pneumoperitoneum in peritoneal dialysis patients; one centre's experience". NDT Plus. 4 (2): 120–3. doi:10.1093/ndtplus/sfq208. PMC 4421564. PMID 25984130.
  13. ^ Kizer KW (May 1980). "Medical hazards of the water skiing douche". Annals of Emergency Medicine. 9 (5): 268–9. doi:10.1016/s0196-0644(80)80387-8. PMID 7369581. Many injuries can result from water skiing accidents, but the water skiing "douche" is unique to this sport. Although generally causing only discomfort, significant trauma can result from the forceful entry of water into the various body orifices.
  14. ^ Jacobs VR, Mundhenke C, Maass N, Hilpert F, Jonat W (Oct 2000). "Sexual activity as cause for non-surgical pneumoperitoneum". JSLS. 4 (4): 297–300. PMC 3113190. PMID 11051188.
  15. ^ Cawich SO, Johnson PB, Williams E, Naraynsingh V (25 Sep 2013). "Non-surgical pneumoperitoneum after oro-genital intercourse". International Journal of Surgery Case Reports. 4 (11): 1048–51. doi:10.1016/j.ijscr.2013.08.022. PMC 3825970. PMID 24121052.
  16. ^ Pfister J, Riedtmann-Klee HJ (September 1993). "[Idiopathic spontaneous pneumoperitoneum. Case discussion based on two cases, assessment procedure and therapy and review of the literature]". Helvetica Chirurgica Acta. 60 (1–2): 49–56. PMID 8226082.
  17. ^ Gutkin Z, Iellin A, Meged S, Sorkine P, Geller E (July 1992). "Spontaneous pneumoperitoneum without peritonitis". International Surgery. 77 (3): 219–23. PMID 1399374.
  18. ^ Khan AN, Chandramohan M (2017-12-06). Coombs BD, Gay SD (eds.). "Pneumoperitoneum Imaging". Emedicine, Medscape. WebMD LLC.
  19. ^ Harkin DW, Blake G (March 1999). "Small bowel obstruction in a young adult". Postgraduate Medical Journal. 75 (881): 173–5. doi:10.1136/pgmj.75.881.173. PMC 1741173. PMID 10448501.
  20. ^ de Lacey G, Bloomberg T, Wignall BK (July 1977). "Pneumoperitoneum: the misleading double wall sign". Clinical Radiology. 28 (4): 445–8. doi:10.1016/s0009-9260(77)80161-x. PMID 872511.
  21. ^ Hirsch M, Cortés C (2009). "El signo de Leo Rigler: doble pared en neumoperitoneo" [The sign of Leo Rigler: double pared in neumoperitoneo.]. Revista chilena de radiología (in Spanish). 15 (3): 152–4. doi:10.4067/S0717-93082009000300008.
  22. ^ Rampton JW (April 2004). "The football sign". Radiology. 231 (1): 81–2. doi:10.1148/radiol.2311011290. PMID 14990817.
  23. ^ Sureka B, Bansal K, Arora A (2015). "Pneumoperitoneum: What to look for in a radiograph?". Journal of Family Medicine and Primary Care. 4 (3): 477–8. doi:10.4103/2249-4863.161369. PMC 4535122. PMID 26288798.
  24. ^ "UOTW #68 - Ultrasound of the Week". Ultrasound of the Week. 22 March 2016. Retrieved 27 May 2017.
  25. ^ Marian K, Monika K, Bartosz K (March 2015). "Spontaneous pneumoperitoneum in a patient after ventilation therapy". Polski Przeglad Chirurgiczny. 86 (12): 601–3. doi:10.1515/pjs-2015-0008. PMID 25803061.

External links edit

December 18, 2023
pneumoperitoneum, pneumatosis, abnormal, presence, other, peritoneal, cavity, potential, space, within, abdominal, cavity, most, common, cause, perforated, abdominal, organ, generally, from, perforated, peptic, ulcer, although, part, bowel, perforate, from, be. Pneumoperitoneum is pneumatosis abnormal presence of air or other gas in the peritoneal cavity a potential space within the abdominal cavity The most common cause is a perforated abdominal organ generally from a perforated peptic ulcer although any part of the bowel may perforate from a benign ulcer tumor or abdominal trauma A perforated appendix seldom causes a pneumoperitoneum PneumoperitoneumFrontal chest X ray The air bubble below the right hemidiaphragm on the left of the image is a pneumoperitoneum SpecialtyGastroenterology Spontaneous pneumoperitoneum is a rare case that is not caused by an abdominal organ rupture This is also called an idiopathic spontaneous pneumoperitoneum when the cause is not known In the mid twentieth century an artificial pneumoperitoneum was sometimes intentionally administered as a treatment for a hiatal hernia This was achieved by insufflating the abdomen with carbon dioxide The practice is currently used by surgical teams in order to aid in performing laparoscopic surgery Contents 1 Causes 2 Spontaneous pneumoperitoneum 3 Diagnosis 3 1 Differential diagnosis 4 Treatment 5 Terminology 6 See also 7 References 8 External linksCauses editPerforated duodenal ulcer The most common cause of rupture in the abdomen Especially of the anterior aspect of the first part of the duodenum Perforated peptic ulcer 1 Bowel obstruction 2 3 Ruptured diverticulum 4 Penetrating trauma 5 Ruptured inflammatory bowel disease e g megacolon 6 Necrotising enterocolitis pneumatosis coli 7 Bowel cancer 8 Ischemic bowel 9 10 11 Steroids After laparotomy After laparoscopy Breakdown of a surgical anastomosis Bowel injury after endoscopy Peritoneal dialysis PD although the prevalence of pneumoperitoneum is estimated to be less than 4 among people with PD in a more recent study in the United Kingdom 12 Vaginal insufflation air enters via the fallopian tubes e g water skiing 13 oral sex 14 15 Colonic or peritoneal infection From chest e g bronchopleural fistula Non invasive PAP positive airway pressure can force air down duodenum as well as down trachea Spontaneous pneumoperitoneum editA spontaneous pneumoperitoneum is a rare case that is not caused by an abdominal organ rupture This is also called an idiopathic spontaneous pneumoperitoneum when the cause is not known 16 Causes of a spontaneous pneumoperitoneum with no peritonitis include a barotrauma due to mechanical ventilation and a tracheal rupture following an emergency intubation In the ventilation case air had passed from the chest into the abdominal cavity through the diaphragm In the tracheal rupture air had passed along the great vessels 17 Diagnosis editWhen present pneumoperitoneum can often be seen on projectional radiography but small amounts are often missed and CT scan is nowadays regarded as a criterion standard in the assessment of a pneumoperitoneum 18 CT can visualize quantities as small as 5 cm of air or gas Signs that can be seen on projectional radiography are shown below The double wall sign marks the presence of air on both sides of the intestine 19 However a false double wall sign can result from two loops of bowel being in contact with one another 20 The sign is named after Leo George Rigler 21 It is not the same as Rigler s triad The football sign is when the abdomen appears as a large oval radiolucency reminiscent of an American football on a supine projectional radiograph 22 The football sign is most frequently seen in infants with spontaneous or iatrogenic gastric perforation causing pneumoperitoneum It is also seen in bowel obstruction with secondary perforation as in Hirschprung disease midgut volvulus meconium ileus and intestinal atresia Iatrogenic causes like endoscopic perforation may also give football sign citation needed The Cupola sign is seen when air is accumulated under the central tendon of the diaphragm 23 nbsp Another pneumoperitoneum on chest X ray nbsp Pneumoperitoneum seen on X ray with the patient lying on his left side nbsp Double wall sign This is a secondary sign of pneumoperitoneum Patient is supine and air within the abdomen and lumen of the bowel accentuate both sides of the bowel wall source source source source source Ultrasound finding of pneumoperitoneum known as peritoneal stripe sign 24 Differential diagnosis edit As differential diagnoses a subphrenic abscess bowel interposed between diaphragm and liver Chilaiditi syndrome and linear atelectasis at the base of the lungs can simulate free air under the diaphragm on a chest X ray citation needed Treatment editTreatment depends on the cause of the condition citation needed Terminology editPneumoperitoneum can be described as peritoneal emphysema 25 just as pneumomediastinum can be called mediastinal emphysema but pneumoperitoneum is the usual name See also editCupola sign Football sign Pneumoretroperitoneum Rigler s signReferences edit Peptic Ulcer Disease The Lecturio Medical Concept Library Retrieved 10 August 2021 Large Bowel Obstruction The Lecturio Medical Concept Library Retrieved 10 August 2021 Small Bowel Obstruction The Lecturio Medical Concept Library Retrieved 10 August 2021 diverticulum Definition of diverticulum in English by Lexico Dictionaries Lexico Dictionaries English Archived from the original on July 17 2019 Retrieved 2019 07 17 Stewart MG 2005 Principles of ballistics and penetrating trauma In Stewart MG ed Head Face and Neck Trauma Comprehensive Management Thieme pp 188 94 ISBN 3 13 140331 4 Retrieved 2008 06 12 Megacolon The Lecturio Medical Concept Library Retrieved 10 August 2021 Necrotizing Enterocolitis Bugs Drugs and Things That Go Bump in the Night Colon Cancer Treatment PDQ NCI May 12 2014 Archived from the original on July 5 2014 Retrieved June 29 2014 Higgins PD Davis KJ Laine L April 2004 Systematic review the epidemiology of ischaemic colitis Alimentary Pharmacology amp Therapeutics 19 7 729 38 doi 10 1111 j 1365 2036 2004 01903 x hdl 2027 42 74164 PMID 15043513 S2CID 9575677 Brandt LJ Boley SJ May 2000 AGA technical review on intestinal ischemia American Gastrointestinal Association Gastroenterology 118 5 954 68 doi 10 1016 S0016 5085 00 70183 1 PMID 10784596 American Gastroenterological Association May 2000 American Gastroenterological Association Medical Position Statement guidelines on intestinal ischemia Gastroenterology 118 5 951 3 doi 10 1016 S0016 5085 00 70182 X PMID 10784595 Archived from the original on 2007 09 27 Imran M Bhat R Anijeet H April 2011 Pneumoperitoneum in peritoneal dialysis patients one centre s experience NDT Plus 4 2 120 3 doi 10 1093 ndtplus sfq208 PMC 4421564 PMID 25984130 Kizer KW May 1980 Medical hazards of the water skiing douche Annals of Emergency Medicine 9 5 268 9 doi 10 1016 s0196 0644 80 80387 8 PMID 7369581 Many injuries can result from water skiing accidents but the water skiing douche is unique to this sport Although generally causing only discomfort significant trauma can result from the forceful entry of water into the various body orifices Jacobs VR Mundhenke C Maass N Hilpert F Jonat W Oct 2000 Sexual activity as cause for non surgical pneumoperitoneum JSLS 4 4 297 300 PMC 3113190 PMID 11051188 Cawich SO Johnson PB Williams E Naraynsingh V 25 Sep 2013 Non surgical pneumoperitoneum after oro genital intercourse International Journal of Surgery Case Reports 4 11 1048 51 doi 10 1016 j ijscr 2013 08 022 PMC 3825970 PMID 24121052 Pfister J Riedtmann Klee HJ September 1993 Idiopathic spontaneous pneumoperitoneum Case discussion based on two cases assessment procedure and therapy and review of the literature Helvetica Chirurgica Acta 60 1 2 49 56 PMID 8226082 Gutkin Z Iellin A Meged S Sorkine P Geller E July 1992 Spontaneous pneumoperitoneum without peritonitis International Surgery 77 3 219 23 PMID 1399374 Khan AN Chandramohan M 2017 12 06 Coombs BD Gay SD eds Pneumoperitoneum Imaging Emedicine Medscape WebMD LLC Harkin DW Blake G March 1999 Small bowel obstruction in a young adult Postgraduate Medical Journal 75 881 173 5 doi 10 1136 pgmj 75 881 173 PMC 1741173 PMID 10448501 de Lacey G Bloomberg T Wignall BK July 1977 Pneumoperitoneum the misleading double wall sign Clinical Radiology 28 4 445 8 doi 10 1016 s0009 9260 77 80161 x PMID 872511 Hirsch M Cortes C 2009 El signo de Leo Rigler doble pared en neumoperitoneo The sign of Leo Rigler double pared in neumoperitoneo Revista chilena de radiologia in Spanish 15 3 152 4 doi 10 4067 S0717 93082009000300008 Rampton JW April 2004 The football sign Radiology 231 1 81 2 doi 10 1148 radiol 2311011290 PMID 14990817 Sureka B Bansal K Arora A 2015 Pneumoperitoneum What to look for in a radiograph Journal of Family Medicine and Primary Care 4 3 477 8 doi 10 4103 2249 4863 161369 PMC 4535122 PMID 26288798 UOTW 68 Ultrasound of the Week Ultrasound of the Week 22 March 2016 Retrieved 27 May 2017 Marian K Monika K Bartosz K March 2015 Spontaneous pneumoperitoneum in a patient after ventilation therapy Polski Przeglad Chirurgiczny 86 12 601 3 doi 10 1515 pjs 2015 0008 PMID 25803061 External links edit Retrieved from https en wikipedia org w index php title Pneumoperitoneum amp oldid 1188109212 Diagnosis, wikipedia, wiki, book, books, library,

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