Pneumoperitoneum: Causes & Reasons

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Possible Causes for Pneumoperitoneum

Laparoscopy

We collected data to compare using this new method of peritoneal insufflation with using Palmer's point for pneumoperitoneum. [ncbi.nlm.nih.gov]

Take the patient out of Trendelenburg position in order to optimize the decompression of the pneumoperitoneum. [web.archive.org]

METHODS: We introduced a new point for Veress needle insertion to create pneumoperitoneum during difficult laparoscopic procedures. [ncbi.nlm.nih.gov]

Gastric Rupture

She was diagnosed with a massive tension pneumoperitoneum, which was decompressed by needle aspiration. [ncbi.nlm.nih.gov]

We recently encountered two cases of gastric rupture with tension pneumoperitoneum that occurred after difficult endotracheal intubation. [ncbi.nlm.nih.gov]

We report a case of a much rarer complication: gastric rupture with pneumoperitoneum. [ncbi.nlm.nih.gov]

Colonic Perforation

[…] than free fluid upper GI perforation tends to present with a relatively large volume of free fluid and less pneumoperitoneum the presence of pneumoperitoneum in the periportal [radiopaedia.org]

Abdominal computed tomography scan showed extensive pneumoperitoneum, pneumoretroperitoneum, pneumomediastinum, and leftsided pneumothorax. [ncbi.nlm.nih.gov]

Pneumoperitoneum due to insufflation of gas at laparoscopy has identical appearances. [radiologymasterclass.co.uk]

Intestinal Perforation

We present two cases of pneumoperitoneum to discuss the non-surgical management of pneumoperitoneum and describe their outcomes. [afrjpaedsurg.org]

Occult spontaneous intestinal perforation (SIP), without pneumoperitoneum on abdominal radiograph, typically occurs in neonates > 2 weeks of age and is usually diagnosed by [ncbi.nlm.nih.gov]

An abdominal X-ray demonstrated extensive PI with pneumoperitoneum mimicking hollow organ perforation. [ncbi.nlm.nih.gov]

Pneumoperitoneum

Introduction Pneumoperitoneum is defined as presence of free air within the peritoneal cavity [1], “Pneumoperitoneum induced Peritonitis” is synonymous of surgical pneumoperitoneum [dx.doi.org]

Pneumoperitoneum: a review of nonsurgical causes. [ncbi.nlm.nih.gov]

[…] cases were selected to be involved in the study, and labeled as surgical pneumoperitoneum or pneumoperitoneum-induced peritonitis. [dx.doi.org]

Pneumatosis Cystoides Intestinalis

PCI with pneumoperitoneum induced by α-glucosidase inhibitor is rare, with only 27 cases (excluding the present case) reported in Japan to date. [ncbi.nlm.nih.gov]

The latter is a sign of pneumoperitoneum. (B) An upright view revealed an air-fluid level and pockets of free air under the diaphragm (arrows). [amjmed.org]

These patients showing pneumoperitoneum or pneumoretroperitoneum are a management dilemma. [transbiomedicine.com]

Duodenal Ulcer Perforation

A chest film (Panel A) showed bilateral pneumoperitoneum (arrows). An exploratory laparotomy revealed a perforated duodenal ulcer with callous borders (Panel B). [nejm.org]

Gas under diaphragm (pneumoperitoneum) was found in 67 (95.71%). [scopemed.org]

Creation of pneumoperitoneum. Insertion of port. Diagnostic laparoscopy & locating the perforation. Cleaning the abdomen. [laparoscopyhospital.com]

Mediastinal Emphysema

We describe a 36 year-old man with SLE, complicated by bilateral pneumothorax, mediastinal emphysema and pneumoperitoneum. [ncbi.nlm.nih.gov]

I thought it was pneumoperitoneum! I blame my mistake on no readers with a small phone! Great case! Why was the patient tachycardic and hypotensive? [ultrasoundoftheweek.com]

Perforated Peptic Ulcer

A chest radiograph revealed a large pneumoperitoneum. She underwent emergent laparoscopic omental patch repair of a perforated ulcer on the anterior wall of her stomach. [ncbi.nlm.nih.gov]

Delayed recognition of perforated peptic ulcer with pneumoperitoneum, bowel distension, and decreased abdominal wall compliance can make up a vicious circle and lead to ACS [ncbi.nlm.nih.gov]

In the absence of pneumoperitoneum on plain X-ray, computed tomography (CT) scan with oral contrast is performed. [symptoma.com]

Perforated Viscus

Pneumoperitoneum was also seen. [ncbi.nlm.nih.gov]

Critics of plain radiography relate that 50 % of patients with a perforated viscus on laparotomy had no findings of pneumoperitoneum of plain film and that 10-14% of pneumoperitoneums [cdemcurriculum.com]

It detects even minute amounts of pneumoperitoneum. [saem.org]

Pneumothorax

After the start of carbon dioxide-induced pneumoperitoneum, the patient's end-tidal carbon dioxide pressure and heart rate suddenly increased. [ncbi.nlm.nih.gov]

We present a case of a patient in whom subcutaneous emphysema, pneumoperitoneum, and pneumothorax occurred on postoperative day 1 after robotic-assisted supracervical hysterectomy [ncbi.nlm.nih.gov]

Less commonly, air can encircle the heart, (Pneumopericardium), get under the skin, (Subcutaneous Emphysema), leak into the abdomen (Pneumoperitoneum) or surround the kidneys [unitypoint.org]

Pulmonary Barotrauma

Massive pneumoperitoneum developing immediately following initiation of artificial ventilation is an unusual sign of pulmonary barotrauma, and must be distinguished from pneumoperitoneum [ncbi.nlm.nih.gov]

Pulmonary barotrauma was defined as the development of pneumothorax, pneumomediastinum, pneumopericardium, or pneumoperitoneum. [ncbi.nlm.nih.gov]

There is also pneumoperitoneum. There is right pleural effusion and areas of higher density in the lung parenchyma corresponding to pneumonic foci. [radiopaedia.org]

Complication of Peritoneal Dialysis

[…] the common noninfectious complications of peritoneal dialysis such as hernias, hydrothorax, hemoperitoneum, pancreatitis, ischemic colitis and necrotizing enterocolitis, pneumoperitoneum [ncbi.nlm.nih.gov]

The incidence of pneumoperitoneum with PD is common. [sjkdt.org]

Carbon dioxide insufflation of the pneumoperitoneum was established through the umbilical port with a Veress needle, and the intraperitoneal pressure was maintained at 15 [e-fjs.org]

Perforated Diverticulitis

Perforated Diverticulum Plain film Pneumoperitoneum secondary to perforation of diverticulum. [stritch.luc.edu]

Fig. 8.5 Colonic perforation: evidence of pneumoperitoneum and air bubbles preferentially located in the pericolic fat ( arrows ) In case of free perforation into the peritoneal [radiologykey.com]

[…] there is evidence of extraluminal contrast (red arrow) from a perforated diverticulum, Conventional Radiography Sentinel loop or, less likely, LBO Air bubbles in abscess Pneumoperitoneum [learningradiology.com]

Toxic Megacolon

[…] more likely to have pneumoperitoneum. [wikiradiography.net]

There may be signs of pneumoperitoneum if dilatation has progressed to cause perforation. barium studies and colonoscopy should be avoided, due to the risk of perforation [radiopaedia.org]

If perforation occurs, radiographic signs of a pneumoperitoneum may be apparent on the supine and/or lateral decubitus radiographs. [13] Clinical examination is not accurate [emedicine.com]

Acute Peritonitis

[…] hemodynamic stability, there are no contraindication to create a pneumoperitoneum when LAPSaroscopic surgery is applicable in cases of peritonitis [wjes.biomedcentral.com]

Abdominal X-rays may reveal dilated, edematous intestines, although such X-rays are mainly useful to look for pneumoperitoneum, an indicator of gastrointestinal perforation [en.wikipedia.org]

As for peritonitis, there is a theoretical concern that the CO 2 pneumoperitoneum may enhance bacteremia and endotoxemia due to the increased intraperitoneal pressure [ 25 [wjes.biomedcentral.com]

Esophageal Perforation

Despite there are few reports of massive gastric distension causing gastric rupture and pneumoperitoneum after CPR, pneumoperitoneum and esophageal rupture has been rarely [austinpublishinggroup.com]

Five patients required additional interventions: four tube thoracostomies for pneumothoraces and one peritoneal drain for pneumoperitoneum. [ncbi.nlm.nih.gov]

A CT scan showed a mediastinal abscess, a right pleural effusion associated with a pneumoperitoneum and peritoneal effusion. Then the patient was transferred to us. [ejcts.oxfordjournals.org]

Diverticulitis of the Colon

[…] fistula bowel: coloenteric fistula or colocolic fistula skin: colocutaneous fistula small bowel obstructions from adhesions or bowel wall edema perforation resulting in pneumoperitoneum [radiopaedia.org]

Plain X-ray of the abdomen showed air under the diaphragm (pneumoperitoneum). The chest X-ray was normal. [saudijgastro.com]

Intestinal Infarction

Splanchnic mucosal ischaemia: An unrecognized consequence of routine pneumoperitoneum. [journalofmas.com]

[…] pneumobilia because gas usually reaches the periphery of the liver while pneumobilia is usually about 2 cm short of external liver border, and is more clustered at the hilum pneumoperitoneum [radiopaedia.org]

Splanchnic mucosal ischemia. an unrecognized consequence of routine pneumoperitoneum. Surg Laparosc Endosc 1997;7:480–482. CrossRef PubMed Google Scholar 44. [doi.org]

Tubo-Ovarian Abscess

The chest X-rays revealed the pneumoperitoneum. [ncbi.nlm.nih.gov]

A case of tubo-ovarian abscess (TOA) presenting with pneumoperitoneum is unusual. [unboundmedicine.com]

PID, STIs 4 2020 Pneumoperitoneum secondary to tubo-ovarian abscess: A case report. [allie.dbcls.jp]

Ischemic Bowel Disease

[…] edema, ascites *pitfall : to assume alternate Dx like infectious colitis when you get the non-specific early findings of mesenteric ischemia Late CT Findings: pneumatosis, pneumoperitoneum [emergencymedicinecases.com]

36%) Plain X-rays are often normal or show non-specific findings. [25] In a series of 73 patients, plain abdominal radiography (56%) showing colic distension in 53% or a pneumoperitoneum [en.wikipedia.org]

Tubal Insufflation

The CO(2) pneumoperitoneum was released, and the woman stabilized spontaneously. The CO(2) pneumoperitoneum was again established, with no further difficulty. [ncbi.nlm.nih.gov]

The duration of CO 2 pneumoperitoneum after laparoscopic surgery has been radiographically shown to resolve within 6 h in most patients, with only minimal amounts of residual [anesthesiology.pubs.asahq.org]

With only minor modifications, the Veress needle is still used today to create pneumoperitoneum for laparoscopy. [kiel-school.de]

Penetrating Abdominal Trauma

TECHNIQUE: After having established pneumoperitoneum and ports placement, the source of bleeding is identified and controlled. [ncbi.nlm.nih.gov]

Peptic Ulcer

Delayed recognition of perforated peptic ulcer with pneumoperitoneum, bowel distension, and decreased abdominal wall compliance can make up a vicious circle and lead to ACS [ncbi.nlm.nih.gov]

Perforation is usually a straightforward diagnosis, often with abundant pneumoperitoneum visible. [radiopaedia.org]

The study showed pneumoperitoneum, contrast stasis in heart with decreased caliber of vessels below the abdominal aortic level, and diffuse lymphedema at the abdominal walls [ncbi.nlm.nih.gov]

Small Bowel Obstruction

[…] clinical and/or CT-scan findings predictive for a surgical treatment (free peritoneal fluid, mesenterial edema, transitional point) or a peritonitis (pneumatosis intestinalis, pneumoperitoneum [ncbi.nlm.nih.gov]

[…] of bowel ischaemia or perforation included: (1) decreased bowel wall enhancement, (2) pneumatosis intestinalis, (3) portal venous gas, and (4) bowel wall perforation with pneumoperitoneum [journals.plos.org]

A large volume pneumoperitoneum secondary to bowel perforation in ASBO can also be detected on plain X-rays, preferably by an erect chest X-ray. [wjes.biomedcentral.com]

Abdominal Surgery

The effects of nitrous oxide and helium pneumoperitoneum compared with carbon dioxide pneumoperitoneum are uncertain. [ncbi.nlm.nih.gov]

In all 21 cases the pneumoperitoneum was established with Veress needle at the Palmer's point and the procedure was carried out after adhesiolysis in 62% of cases. [ncbi.nlm.nih.gov]

Intracranial pressure rises during pneumoperitoneum. [intechopen.com]

Lymphangioleiomyomatosis

Intradermal Injection of Indigo Carmine for Sentinel Node Mapping - 2013 Effects of high positive end-expiratory pressure on haemodynamics and cerebral oxygenation during pneumoperitoneum [medicine.gachon.ac.kr]

[…] loss Blood in sputum Headache Pain abdomen Complications Ascites Pleural effusion pneumothorax Chylothorax H emoptysis Chyloptysis Chyluria Haematuria Pericardial effusion Pneumoperitoneum [wikidoc.org]

[…] hemorrhage. [19] Other complications of lymphangioleiomyomatosis (LAM) include the following: Hemoptysis Chylothorax Ascites Chyloptysis Chyluria Hematuria Pericardial effusion Pneumoperitoneum [emedicine.medscape.com]

Cardiopulmonary Resuscitation

Pneumomediastinum/oesophagus haematoma, n 4 — — Pleural fluid/blood, n 1 3 3 Lung contusion/haematoma, n 1 — 1 Liver rupture, n 1 2 — Intracranial air embolism, n 1 — — Pneumoperitoneum [doi.org]

Mechanical Ventilation

This can manifest as pneumothorax, pneumoperitoneum, subcutaneous emphysema, pneumomediastinum and can sometimes progress to bronchopleural fistula or tension pneumothorax [clinicaladvisor.com]

[…] of increase in airway resistance (bronchospasm, obstructed tube) or decrease in compliance of the respiratory system (obesity, atelectasis, selective intubation, surgical pneumoperitoneum [ccforum.biomedcentral.com]

Ulcerative Colitis