Conservative management of pneumatosis intestinalis and massive pneumoperitoneum in the acute abdomen: a case report

Brill, Simon; Skipworth, James; Stoker, David L.

doi:10.1308/147870808x257193

Cited by 12 publications

(18 citation statements)

References 2 publications

(5 reference statements)

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“…The treatments for pneumoperitoneum and pneumoretroperitoneum are also mainly supportive except in cases with obvious peritonitis or sepsis [14,15]. …”

Section: Discussionmentioning

confidence: 99%

Bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema after percutaneous tracheostomy -A case report-

Kim

2012

Korean J Anesthesiol

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We report a rare case of a 72-year-old female who developed extensive subcutaneous emphysema, bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, and pneumoretroperitoneum after a percutaneous dilatational tracheostomy. The patient's T-cannula was accidentally connected to the oxygen line with a non-perforated connector. The patient rapidly developed respiratory insufficiency and subcutaneous emphysema in the neck and both shoulders. The bilateral pneumothoraces were managed using a chest tube. CT scans of the chest, abdomen, and pelvis revealed an extensive distribution of air throughout the chest and abdomen. The patient was treated successfully with supportive care. This case illustrates the rare occurrence of air passing into multiple body compartments, highlighting the potentially serious complications of a tracheostomy and the importance of intensive care during the recovery period.

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“…The treatments for pneumoperitoneum and pneumoretroperitoneum are also mainly supportive except in cases with obvious peritonitis or sepsis [14,15]. …”

Section: Discussionmentioning

confidence: 99%

Bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema after percutaneous tracheostomy -A case report-

Kim

2012

Korean J Anesthesiol

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“…A recent article by Brill et al [13] has described a case of PI managed successfully by non-operative measures as the patient did not have any sign of perotinism. Importantly, benign pneumoperitoneum from PI (presumably due to rupture of gaseous cysts without communication with GI tract lumen) in the absence of perotinitis can be treated conservatively.…”

Section: Discussionmentioning

confidence: 99%

A lethal case of pneumatosis intestinalis complicated by small bowel volvulus

Liau

Cope

MacFarlane

et al. 2008

Clin J Gastroenterol

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Pneumatosis intestinalis (PI) is a condition characterised by gas-filled cystic malformations on the intestinal wall. It is often secondary to an underlying disease process. We describe the case of a 76-year-old gentleman who presented with intermittent abdominal pain, altered bowel habits and weight loss. Barium enema was unremarkable, apart from sigmoid diverticulosis. CT scan found evidence of pneumatosis on small bowel walls with benign pneumoperitoneum. As there was no sign of intra-abdominal crisis, he was initially treated conservatively. Unfortunately, he required re-admission 6 weeks later with symptoms of bowel obstruction and clinical signs of perotinitis. At laparotomy, he was found to have extensive small bowel infarction due to volvulus from 'twisting' around the axis of superior mesenteric vessels. Evidently, this occurred secondary to a congenitally long small bowel mesentery that predisposed him to volvulus. Extensive small bowel resection was performed. The postoperative course was complicated by persistent hypotension, which proved fatal. This case report draws attention to the rare association between PI and small bowel volvulus predisposed by a congenitally long mesentery, which can present initially with a benign picture (intermittent, reversible volvulus), but subsequently be complicated by lethal bowel infarction (irreversible volvulus). This case raises several issues about the management of this rare condition. Clinicians must realise that PI, though often benign, can present with lethal complications, and early recognition of such complications can be life-saving.

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“…(5)(6)(7)(8)(10)(11)(12)(13)(14)17,(19)(20)(21)(22)(23)(26)(27)(28)(29)(30)(31)(32)(33)(34)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50) It is mainly due to the lack of knowledge of the attending physicians which leads to unnecessary laparotomy with possible morbidity. (6) When we acknowledge the possibility of non-surgical pneumoperitoneum, the primary goal is to discern surgical from non-surgical pneumoperitoneum.…”

Section: Definition and Aetiologymentioning

confidence: 99%