The enigma of asymptomatic idiopathic pneumoperitoneum: A dangerous trap for general surgeons

Abstract

Highlights The aetiology of spontaneous pneumoperitoneum includes a variety of intrathoracic, gynaecologic, intra-abdominal and iatrogenic causes. Idiopathic pneumoperitoneum is an extremely rare condition where no clear cause has been found and the patient has no risk factors. Knowledge of this rare phenomenon can reduce the negative laparotomy rate in such patients.

Management of incidentally detected idiopathic pneumoperitoneum: A case report and literature review

“…Early diagnosis is essential for GI perforation, and delayed management is reported to increase mortality [6] . However, there are numerous other causes of pneumoperitoneum that do not require urgent surgical intervention ( Table 2 ) [4] . The initial clinical manifestations of pneumoperitoneum are variable and range widely, from asymptomatic to septic shock.…”

“…We performed a literature review of asymptomatic IP and found two cases published in English [3] , [4] and eight cases in Japanese [12] , [13] , [14] , [15] , [16] , [17] , [18] ( Table 3 ). Six men and four women with a mean age of 72.9 (range 52–85) years were reported.…”

“…The management of incidentally detected asymptomatic IP has yet to be established, not only because of its rarity but also the diversity of the clinical presentations. To the best of our knowledge, there have been two published case reports in the English literature describing asymptomatic IP [3] , [4] . We report herein a case of incidentally detected asymptomatic IP.…”

Asymptomatic pneumoperitoneum or pneumatosis cystoides intestinalis? Easy to make a mistake

“…Some reports also revealed associations of PCI with chemotherapy, hormonal therapy, connective tissue disease, immunosuppression and organ transplant [ 2 ]. Clinically, PCI is asymptomatic and harmless at diagnosis and it is incidentally revealed during endoscopy, imaging examination or surgery [ 9 ].…”

“…A visceral perforation accounts for 85 to 95% of all cases and generally indicates a surgical emergency [ 1 ]. However, in about 10% of cases a variety of benign conditions could also determine a spontaneous pneumoperitoneum that do not require any surgical intervention ( Table 1 ) [ 2 ]. In these cases, pneumoperitoneum is frequently asymptomatic and incidentally detected by radiological investigations.…”