PP patients may have a medical history of gastrointestinal disease or recent surgery, and corresponding anamnestic data should be considered when interpreting clinical signs, before deciding on a therapeutic approach. While the presence of free air in the peritoneal cavity cannot be diagnosed during a general examination, abdominal distension, intense pain, rigidity and rebound tenderness are indicative of peritonitis and possibly GIT perforation. In these cases, bowel sounds are usually absent and patients present constitutive symptoms like fever, volume depletion, hypotension and tachycardia; they may suffer from nausea and vomiting. Furthermore, patients may report not to have passed stools or gasses since symptom onset [1].

In contrast, postoperative PP doesn't generally cause major complaints, and mild to moderate abdominal distension and pain may merely result from the underlying disease or surgery. This condition should normalize within a week.

• Fever

  Patients with small bowel perforation may present with a prolonged history of fever followed by the appearance of pain in lower abdomen. [ncbi.nlm.nih.gov]

  After 4 days of hospitalisation, the patient developed low-grade fever of (38.5 oC), while the patient’s abdominal physical exam was normal except for distention. [emjreviews.com]

  Lesions predisposing to this accident are as follows: gastric or duodenal ulcer; ileal ulcer complicating typhoid fever; rupture of the urinary bladder, and perforating abdominal wounds. [pubs.rsna.org]

• Candidiasis

  SIP is frequently associated with systemic candidiasis or coagulase-negative Staphylococcus. It does not have the clinical signs that NEC has (see Chapter 131). Spontaneous colonic perforations. These can occur but are very rare. [accesspediatrics.mhmedical.com]

• Respiratory Disorders

  Pneumoperitoneum associated with a respiratory disorder (eg, pulmonary interstitial emphysema [PIE], pneumomediastinum, or pneumothorax). [accesspediatrics.mhmedical.com]

• Peritoneal Disease

  Medium hochladen Wikipedia Ist ein(e) Krankheit Unterklasse von peritoneal disease, Emphysem Normdatei Q163469 Reasonator Scholia Statistik Unterkategorien Es werden 2 von insgesamt 2 Unterkategorien in dieser Kategorie angezeigt: In Klammern die Anzahl [commons.wikimedia.org]

  Disease or Syndrome pneumoperitoneum Subclass of: Peritoneal Diseases Definitions related to pneumoperitoneum: A condition with trapped gas or air in the PERITONEAL CAVITY, usually secondary to perforation of the internal organs such as the LUNG and the [openmd.com]

• Abdominal Girth Increased

  Report of a Case A 63-year-old man with a long-standing history of alcohol abuse was admitted to the hospital in September 1980 with increasing abdominal girth, increasing [jamanetwork.com]

Abdominal imaging is the mainstay of PP diagnosis. To this effect, plain radiography has long since been the technique of first choice. Very small volumes of free gas - as little as 1 ml - can be observed in images obtained by means of this technique. Upright, anterior-posterior chest radiographs are most suited and typically depict a translucent, crescent area below the diaphragm [7]. The Rigler's sign may be observed; it corresponds to the display of both sides of the intestinal wall [8]. Similarly, the telltale triangle sign implies PP: A triangle of gas may be visualized between three adjoining bowel loops, or two loops and the peritoneal wall [9]. In emergency settings, radiographs may be obtained from a patient in the supine decubitus position.

Computed tomography scans may be reserved for doubtful cases. Its superior spatial resolution is helpful to localize minimum quantities of free gas and to distinguish PP from pseudo- pneumoperitoneum. The latter term refers to any condition that mimics PP, such as pneumatosis cystoides intestinalis and interposition of viscera [10].

• Pneumoperitoneum

  Pneumoperitoneum Treatment of Pneumoperitoneum Continuing Medical Education (CME) CME Programs on Pneumoperitoneum International Pneumoperitoneum en Espanol Pneumoperitoneum en Francais Business Pneumoperitoneum in the Marketplace Patents on Pneumoperitoneum [wikidoc.org]

  Once the diagnosis of pneumoperitoneum is stated, the next step is to treat the cause; surgery is indicated if contrast and/or free intra-abdominal fluid is found in the abdomen, not only due to the presence of pneumoperitoneum. [hindawi.com]

  Pneumoperitoneum Frontal chest X-ray. The air bubble below the right hemidiaphragm (on the left of the image) is a pneumoperitoneum. [en.wikipedia.org]

• X-Ray Abnormal

  Abdominal X-ray - Abnormal bowel gas pattern Free gas/pneumoperitoneum Key points Bowel perforation is a surgical emergency An ERECT chest X-ray should be requested if perforation is suspected Be familiar with Rigler's sign Free gas, or pneumoperitoneum [radiologymasterclass.co.uk]

• Hyponatremia

  Hyponatremia can be seen with NEC secondary to third spacing of fluid. Thrombocytopenia also can be seen. Arterial blood gas levels. May reveal hypoxemia and increasing Pco2 levels. Metabolic acidosis can be seen with peritonitis. Blood culture. [accesspediatrics.mhmedical.com]

[…] patient#4 Image courtesy of RadsWiki and copylefted Large pneumoperitoneum after indomethicin treatment patient#4 Image courtesy of RadsWiki and copylefted CT CT can visualize quantities as small as 5 cm³ of air or gas. [wikidoc.org]

Once the fistula is diagnosed, treatment options are several. Conservative versus operative treatment is currently a matter of debate generally regarding timing, patient's condition and fistula's size. [ncbi.nlm.nih.gov]

Conservative «in situ» treatment of pneumoperitoneum. Cir Esp, 93 (2015), pp. 127-129 [10] M.T. Macklin, C.C. Macklin. [archbronconeumol.org]

Delay in recognizing and treatment can significantly worsen prognosis. In neonate with intestinal perforation one should consider Hirschsprung's disease. [ncbi.nlm.nih.gov]

In 1957 Wolcott and Murphy 1 stated that the prognosis and management of lung abscess has changed dramatically in the past 15 years. They reported on 70 patients treated since 1941. [jamanetwork.com]

Asymptomatic pneumomediastinum has good prognosis and it resolves spontaneously. Pneumopericardium and pneumoperitoneum are rare event. But when pneumomediastinum is accompanied with pneumopericardium and symptomatic, the prognosis gets worse. [omicsonline.org]

Treatment The treatment and prognosis of pneumoperitoneum depend on its cause. The initial step of treatment is identifying the underlying condition that causes the air retention within the peritoneal cavity. [hubpages.com]

The most well-accepted etiology is an increase in arterial and venous pressures causing the rupture of subcutaneous capillaries, although the exact etiology remains unclear. [ncbi.nlm.nih.gov]

"Systematic review: the epidemiology of ischaemic colitis". Alimentary Pharmacology & Therapeutics. 19 (7): 729–38. doi:10.1111/j.1365-2036.2004.01903.x. hdl:2027.42/74164. PMID 15043513. S2CID 9575677. ^ Brandt LJ, Boley SJ (May 2000). [en.wikipedia.org]

Stroup DF, Berlin JA, Morton SC, et al; Meta-analysis of Observational Studies in Epidemiology (MOOSE) Group. Meta-analysis of observational studies in epidemiology: a proposal for reporting. JAMA. 2000;283(15):2008-2012. [jamanetwork.com]

Rare cases of idiopathic pneumoperitoneum have been described in the literature, the underlying causes and pathophysiology of which remain uncertain. [ncbi.nlm.nih.gov]

The picture of a massive pneumoperitoneum can be shocking at the time of diagnosis but understanding the pathophysiology of its occurrence supports the decision of nonsurgical management. [emjreviews.com]

To prevent pneumatic perforation during upper GI endoscopy, patients should be well prepared and fasted prior to the examination. [dx.doi.org]

A subphrenic abscess will prevent the accumulation of air in the subdiaphragmatic space. 2. To study the liver outline. [pubs.rsna.org]

Team involvement and examination under anaesthesia could have prevented a laparatomy in this situation. [academic.oup.com]

The term pneumoperitoneum (PP) refers to the presence of gas within the peritoneal cavity. Most commonly, this gas originates from the gastrointestinal tract (GIT) and thus indicates a disruption of its physical integrity. Any part of the GIT may be affected and PP may complicate diseases like gastric ulcer, mesenteric infarction, toxic megacolon, and abdominal cancer. Interestingly, perforated appendicitis seldom entails PP [1]. Rarely, emphysematous inflammation of abdominal organs may give rise to PP [2]. PP may also occur after penetrating abdominal trauma or abdominal surgery. Postoperative PP may or may not indicate leaking anastomoses, since air may be introduced into the peritoneal cavity during surgery [3]. Indeed, PP may be induced intentionally by insufflation of carbon dioxide or helium to facilitate laparoscopic procedures and intraperitoneal chemotherapy [4]. Although such a measure may be contraindicated in patients suffering from cardiorespiratory disorders and increased intracranial pressure [5] [6], the presence of gas within the abdominal cavity per se is not detrimental. However, pathological PP as described above is virtually always associated with the presence of pathogens and toxins in the peritoneal cavity. Therefore, it is an indicator of a life-threatening situation that requires emergency surgery.

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