How to distinguish between surgical and non-surgical pneumoperitoneum?

Čečka, Filip; Sotona, O; Subrt, Z

doi:10.22514/sv91.042014.1

Cited by 14 publications

(21 citation statements)

References 42 publications

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“…Intermittent positive-pressure ventilation, especially with high peak inspiratory pressures, can lead to air leakage into the abdominal cavity [5]; barotrauma causing pneumomediastinum, and subsequently pneumoperitoneum, has been described [6]. Other thoracic causes of SP that have been noted include asthma [7], chronic obstructive pulmonary disease (COPD) [8], cardiopulmonary resuscitation [9], and even severe coughing spells [3]. The most common intra-abdominal cause of SP is pneumatosis cystoides intestinalis, a rare condition characterized by the presence of submucosal and subserosal air-filled cysts throughout the gastrointestinal tract [10].…”

Section: Discussionmentioning

confidence: 99%

“…As such, treatment is often supportive with supplemental oxygen, and most cases typically follow a benign course and resolve spontaneously. Pneumoperitoneum following abdominal surgery and endoscopy is another complication that, in most cases, is completely resorbed a few weeks after the procedure [3]. In women, free air can be transmitted through the genital tract to the peritoneal cavity under multiple conditions.…”

Section: Discussionmentioning

confidence: 99%

“…Sexual intercourse, predominantly post-hysterectomy, has been reported to cause SP [11]. Vaginal douching, insufflation, and even pelvic inflammatory disease have been associated with non-surgical pneumoperitoneum [3]. Several bizarre incidences of SP have been documented after jacuzzi usage [12], scuba diving [13], and even knee-chest exercises [14].…”

Section: Discussionmentioning

confidence: 99%

“…Etiologies of this phenomenon are broad and can include intrathoracic, intra-abdominal, and gynecologic causes [3]. Patients with SP are often managed conservatively, and exploratory surgery is warranted only if the clinical features of peritonitis are present.…”

Section: Introductionmentioning

confidence: 99%

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Massive Pneumoperitoneum Presenting as an Incidental Finding

Wang

Batra

2018

Cureus

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Pneumoperitoneum is often associated with surgical complications or intra-abdominal sepsis. While commonly deemed a surgical emergency, pneumoperitoneum in a minority of cases does not involve a viscus perforation or require urgent surgical management; these cases of “spontaneous pneumoperitoneum” can stem from a variety of etiologies. We report a case of a 72-year-old African American male with a history of metastatic pancreatic adenocarcinoma who presented with new-onset abdominal distention and an incidentally discovered massive pneumoperitoneum with no clear source of perforation on surveillance imaging. His exam was non-peritonitic, so no surgical intervention was recommended. He was treated with bowel rest, intravenous antibiotics, and hydration. He had a relatively benign clinical course with preserved gastrointestinal function and had complete resolution of his pneumoperitoneum on imaging two months after discharge. This case highlights the importance of considering non-surgical causes of pneumoperitoneum, as well as conservative management, when approaching patients with otherwise benign abdominal exams.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Massive Pneumoperitoneum Presenting as an Incidental Finding

Wang

Batra

2018

Cureus

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“…Unlike enteric anastomotic dehiscence, which often presents with pneumoperitoneum and frequently causes peritonitis [20], pancreatic leak is more frequent, but the clinical course is not usually so dramatic [4]. Pancreatic leak or pancreatic fistulae can be easily diagnosed by analysing the amylase concentration in the drain effluent [21].…”

Section: Introductionmentioning

confidence: 99%

DRAPA trial – closed-suction drains versus closed gravity drains in pancreatic surgery: study protocol for a randomized controlled trial

Čečka

Loveček

Jon

et al. 2015

Trials

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BackgroundThe morbidity of pancreatic resection remains high, with pancreatic fistula being the most common cause. The important question is whether any postoperative treatment adjustment may prevent the development of clinically significant postoperative pancreatic fistulae. Recent studies have shown that intraabdominal drains and manipulation using them are of great importance. Although authors of a few retrospective reports have described good results of pancreatic resection without the use of intraabdominal drains, a recent prospective randomized trial showed that routine elimination of drains in pancreaticoduodenectomy is associated with poor outcome. An important issue arises as to which type of drain is most suitable for pancreatic resection. Two types of surgical drains exist: open drains and closed drains. Open drains are considered obsolete nowadays because of frequent retrograde infection. Closed drains include two types: passive gravity drains and closed-suction drains. Closed-suction drains are more effective, as they remove fluid from the abdominal cavity under light pressure. However, some surgeons believe that closed-suction drains represent a potential hazard to patients and that negative pressure might increase the risk of pancreatic fistulae. Nobody has yet specifically dealt with the question of which kind of drainage is most appropriate in pancreatic surgery.Methods/DesignThe aim of the DRAins in PAncreatic surgery (DRAPA) trial is to compare the closed-suction drain versus the closed passive gravity drain in pancreatic resection. DRAPA is a dual-centre, prospective, randomized controlled trial. The primary endpoint is the rate of postoperative pancreatic fistula; the secondary endpoint is postoperative morbidity with follow-up of 3 months.DiscussionNo study to date has compared different types of drains in pancreatic surgery. This study is designed to answer the question whether any particular type of drain might lower the rate of postoperative pancreatic fistula or other complications.Trial registrationClinicalTrials.gov Identifier: NCT01988519. Registered 13 November 2013.

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The clinical dilemma of the persistent idiopathic pneumoperitoneum: A case report

Hannan

Saad

Hoashi

et al. 2019

International Journal of Surgery Case Reports

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HighlightsIdiopathic pneumoperitoneum is a rare clinical entity that is challenging to identify and manage.Unneccessary surgical intervention in idiopathic pneumoperitoneum can lead to significant morbidity and even mortality.Conservative treatment with close observation is optimal if no peritonitis or radiological evidence of perforation.Contrast-enhanced CT may help exclude gastrointestinal perforation with 86% accuracy and thus help avoid unnecessary surgical intervention.

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How to distinguish between surgical and non-surgical pneumoperitoneum?

Abstract: Not all cases of pneumoperitoneum found on abdominal X-ray or computed tomography (CT) SIGNA VITAE 2014; 9(1) ): 1 -7

Cited by 14 publications

References 42 publications

Massive Pneumoperitoneum Presenting as an Incidental Finding

Massive Pneumoperitoneum Presenting as an Incidental Finding

DRAPA trial – closed-suction drains versus closed gravity drains in pancreatic surgery: study protocol for a randomized controlled trial

The clinical dilemma of the persistent idiopathic pneumoperitoneum: A case report

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