Pneumoperitoneum as a finding on imaging examinations is not always a sign of acute abdomen due to gastrointestinal perforation. These findings must be viewed in connection with the clinical condition and personal history of each patient because they may also indicate a non-surgical or spontaneous pneumoperitoneum. This condition is repeatedly described but very often neglected. This paper presents the case report of a patient with non-surgical pneumoperitoneum where, despite proceeding according to the guidelines, no expected intra-abdominal pathology explaining the patient's problems was found.
- Keywords
- non-surgical pneumoperitoneum, pneumatosis cystoides intestinalis, pneumoperitoneum, spontaneous pneumoperitoneum,
- MeSH
- Humans MeSH
- Pneumatosis Cystoides Intestinalis * complications diagnostic imaging therapy MeSH
- Pneumoperitoneum * diagnostic imaging etiology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
INTRODUCTION: The paper presents unusual symptoms as a complication of therapeutic colonoscopy. CASE REPORT: A 70-year-old polymorbid female patient in chronic dialysis program underwent argon plasma coagulation treatment of leaking angioectasias in the cecum and ascending colon. Shortly after the procedure she presented with shortness of breath and subcutaneous emphysema of the neck which was initially misdiagnosed as swelling. Further tests revealed pneumoperitoneum, subcutaneous emphysema and pneumomediastinum. Considering the high risks for our patient (comorbidities, obesity), a laparoscopic approach was indicated. During laparoscopy neither peritonitis nor intestinal perforation were found. The patient recovered without complications after further complex treatment. CONCLUSION: Shortness of breath and subcutaneous emphysema are not typically among the first symptoms of colonoscopic perforation. Our case confirms that we should bear this complication in mind and when suspected, the diagnostic process should be started without delay.
- Keywords
- argon plasma coagulation, iatrogenic colonoscopic perforation, pneumoperitoneum, subcutaneous emphysema,
- MeSH
- Argon Plasma Coagulation adverse effects MeSH
- Humans MeSH
- Mediastinal Emphysema * therapy complications MeSH
- Pneumoperitoneum * etiology therapy MeSH
- Pneumothorax * diagnosis MeSH
- Aged MeSH
- Subcutaneous Emphysema * etiology therapy diagnosis MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
Colon perforation is a very serious complication of colonoscopy. The correct diagnosis and management of therapy improve the prognosis of patients. The treatment can be conservative, endoscopic and surgical. In this case report we present microperforation as a complication of polypectomy in the caecum during colonoscopy, followed by laparoscopic surgery.Key words: colonoscopy - complication -perforation polypectomy.
- MeSH
- Cecum MeSH
- Colon MeSH
- Colonoscopy * adverse effects MeSH
- Humans MeSH
- Colonic Diseases * MeSH
- Intestinal Perforation * etiology surgery MeSH
- Pneumoperitoneum * etiology surgery MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
INTRODUCTION: Hirschsprung's disease is a congenital colonic aganglionosis, usually presented as inability or difficulty in passing of meconium, chronic and persistent obstipation, maleficent feeding, vomiting, distension and lethargy. CASE PRESENTATION: We presented a case of an in-vitro conceived quadruplet premature neonate who presented with pneumoperitoneum caused by transverse colon spontaneous perforation and microcolon appearance of distal bowel, treated by resection and temporary colostomy turns to be a rare manifestation of Hirschsprung's disease. CONCLUSION: Assisted reproductive technologies increases chances for multiple pregnancies and may increase chance for major congenital anomalies. Rare manifestation of Hirschsprung's disease is spontaneous pneumoperitoneum which remains a surgical emergency. Delay in recognizing and treatment can significantly worsen prognosis. In neonate with intestinal perforation one should consider Hirschsprung's disease.
- Keywords
- Hirschsprung disease, In vitro fertilization, Pneumoperitoneum, quadruplets,
- MeSH
- Quadruplets * MeSH
- Fertilization in Vitro MeSH
- Hirschsprung Disease complications diagnosis surgery MeSH
- Humans MeSH
- Infant, Premature MeSH
- Infant, Newborn MeSH
- Pneumoperitoneum diagnosis etiology surgery MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Infant, Newborn MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
The authors submit case-histories of patients with an X-ray finding of pneumoperitoneum on a native X-ray of the abdomen. Air in the abdominal cavity was proved in the majority of cases also on laparotomy, however, the source of air was not found. The authors mention four cases from their own department. In the first female patient with a generalized gynaecological tumour pneumoperitoneum was diagnosed repeatedly before surgery. In the second case a female patient was involved with an inoperable pancreatic tumour; obstruction of the biliary pathways was resolved by an endoscopically inserted stent. In that case too the pneumoperitoneum was repeatedly detected before surgery. The third patient with a generalized ovarian tumour, acute abdominal pain and pneumoperitoneum died on the second day after operation. Similarly as patient 2 on necropsy thrombosis of the portal vein was found. In the 4th case the finding of pneumoperitoneum was made after diagnostic technically difficult gastroscopy. This patient was not operated. Patients 1-3 were operated without evidence of perforation of the digestive tract. For illustration cases described in the literature are quoted. The causes of non-surgical pneumoperitoneum are classified according to the anatomical site of development. The author describes the assumed mechanisms of development of non-surgical pneumoperitoneum. In the discussion aspects are mentioned which decide on conservative or surgical treatment of pneumoperitoneum.
- MeSH
- Middle Aged MeSH
- Humans MeSH
- Pneumoperitoneum diagnosis etiology therapy MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- English Abstract MeSH
- Journal Article MeSH
The authors present an account on 9 patients who were detected in their department during the nine-year period from 1991-2000 with the finding of pneumoperitoneum where perforation of the digestive tract was not proved. In 4 of them (44%) conservative treatment was used, in the remaining 5 patients (56%) the condition called for surgical revision. The latter was made as an acute operation in four patients because of signs of peritoneal irritation, in one only after 4 days because of suspected tumours intestinal disease. As to the site of the assumed source of the non-perforation pneumoperitoneum we included 6 of them into the group abdominal area, (1x pneumatosis cystoides intestinalis, 1x aerogenic infection from a perforated abscess of the right liver lobe, 2x microtraumas of the wall of the cardio-esophageal transition with massive vomiting, 1x microtraumas of the lesser curvature of the stomach during extreme distension of the stomach after incorrect intubation and resuscitation, 1x passage of gas through the inflamed distended colonic wall in colitis), two patients into the thoracic area (1x in conjunction with pneumothorax, 1x with hydrothorax), 1 patient in the urogenital area (by the gynaecological route after repeated coitus and orogenital practices). The authors summarize on the basis of data in the literature and their own experience diagnostic and therapeutic possibilities of this relatively rare finding.
- MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Intestinal Perforation complications MeSH
- Pneumoperitoneum * diagnosis etiology therapy MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- English Abstract MeSH
- Journal Article MeSH
The authors describe the finding of extensive tensive pneumoperitoneum which developed during distension therapy (CNP) in an immature neonate. The absence of another extraalveolar cumulation of air made the authors use PO2 analysis in the peritoneal air by means of a transcutaneous electrode. Because the PO2 rose after connection of the electrode to the catheter draining the abdominal cavity, the authors assumed a respiratory aetiology of the pneumoperitoneum and did not consider laparatomy. They assume that the above test may be valuable in the differential diagnosis between respiratory and gastrointestinal pneumoperitoneum in those instances where it is not possible to assess the aetiology of pneumoperitoneum unequivocally.
- MeSH
- Humans MeSH
- Infant, Newborn MeSH
- Pneumoperitoneum etiology therapy MeSH
- Respiratory Insufficiency etiology MeSH
- Respiratory Distress Syndrome, Newborn complications therapy MeSH
- Check Tag
- Humans MeSH
- Infant, Newborn MeSH
- Publication type
- English Abstract MeSH
- Journal Article MeSH
- Case Reports MeSH
- MeSH
- Adult MeSH
- Humans MeSH
- Pneumatosis Cystoides Intestinalis complications diagnosis MeSH
- Pneumoperitoneum diagnosis etiology MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
- MeSH
- Humans MeSH
- Pneumoperitoneum etiology MeSH
- Child, Preschool MeSH
- Respiration, Artificial adverse effects MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Child, Preschool MeSH
- Publication type
- English Abstract MeSH
- Journal Article MeSH
- Case Reports MeSH
