Pathophysiology, recognition and management of pneumoretroperitoneum

Prêtre, René; Robert, Jean; Mirescu, D; Witzig, J A; Rohner, A

doi:10.1002/bjs.1800800923

Cited by 26 publications

(13 citation statements)

References 6 publications

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“…The presence of air in the retroperitoneum and its early recognition and detection of the source are important, to rule out an unobserved serious cause [1].It is also imperative to recognize the cases in which pneumoretroperitoneum is not caused by perforation of the retroperitoneal hollow viscus. Recognition of these cases may prevent unnecessary laparotomies.…”

Section: Discussionmentioning

confidence: 99%

“…Rare pathologies, such as open reduction and internal fixation of femoral fractures and anaerobic abscess of the hip joint have also been described in relation to this complication [1,2]. A rare case of pneumoretroperitoneum caused by insufflation of air during an attempt to achieve epidural anesthesia is described.…”

Section: Introductionmentioning

confidence: 99%

“…

AbstractAir may extend to the retroperitoneal space from retroperitoneal perforation of a hollow viscus, infection of the anterior pararenal space with gas-forming organisms and from pneumothorax or pneumomediastinum [1]. Rare pathologies, such as open reduction and internal fixation of femoral fractures and anaerobic abscess of the hip joint have also been described in relation to this complication [1,2].

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mentioning

confidence: 99%

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Pneumoretroperitoneum after Attempted Epidural Anesthesia

Isakov

Shtein

Kyzer

2016

The Journal of Critical Care Medicine

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Air may extend to the retroperitoneal space from retroperitoneal perforation of a hollow viscus, infection of the anterior pararenal space with gas-forming organisms and from pneumothorax or pneumomediastinum [1]. Rare pathologies, such as open reduction and internal fixation of femoral fractures and anaerobic abscess of the hip joint have also been described in relation to this complication [1,2]. A rare case of pneumoretroperitoneum caused by insufflation of air during an attempt to achieve epidural anesthesia is described. Case reportAn 81-year-old, Caucasian, male, weight 72 kg, height 178 cm, was admitted due to fracture of the neck of the right femur. The patient was operated on, and internal fixation of the fracture was performed. Epidural anesthesia at the L4-5 level in the right the lateral position was performed by a second-year anesthesia resident. A midline approach and an 18G Tuohy needle were used. The procedure was technically difficult, and a total of three attempts were made. Loss of resistance with air was used. During the efforts to identify the epidural space, some 30 to 35 milliliters of air had been injected. Subjective loss of resistance was reported by the performing anesthesiologist. However, he was unable to insert an epidural catheter. Local anesthetic was not injected. The procedure was eventually carried out without intraoperative complications under general anesthesia. On the fourth postoperative day, the patient developed continuous abdominal pain of moderate severity. On examination, there were no signs of peritoneal irritation. However, an abdominal CT scan demonstrated air in the retroperitoneum around the left psoas muscle (Figure 1). Because the patient had received an enema on the third postoperative day, a gastrografin enema was performed to rule out rectal or colonic perforation. No leak was demonstrated. CT examination confirmed air around the left psoas muscle which extended to the left paravertebral muscles. There was no air around the pelvic organs or at the site of the femoral fixation. The patient's condition improved gradually, and he was discharged on the seventh postoperative day. The patient agreed with presentation of his data and all the procedures performed were approved by the institution where the patient was treated.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pneumoretroperitoneum after Attempted Epidural Anesthesia

Isakov

Shtein

Kyzer

2016

The Journal of Critical Care Medicine

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“…Fever and leukocytosis are other objective findings of perforation. Radiological diagnosis is based on chest and abdominal radiography and CT scan (22). Abdominal CT scan plays an important role in identifying an occult perforation and whole body CT allows to evaluate the extension of escaped gas to different body districts.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment is directed to solve the perforation through laparotomy or laparoscopy with removal of the site of perforation (22)(23)(24)(25). If mediastinitis has occurred, treatment of this dangerous complication is required with antibiotic therapy or surgical drainage.…”

Section: Discussionmentioning

confidence: 99%