Does pneumoperitoneum always require laparotomy? Report of six cases and review of the literature
PEDIATRIC SURGERY INTERNATIONAL, vol.21, no.10, pp.819-824, 2005 (SCI-Expanded, Scopus)
- Publication Type: Article / Review
- Volume: 21 Issue: 10
- Publication Date: 2005
- Doi Number: 10.1007/s00383-005-1489-3
- Journal Name: PEDIATRIC SURGERY INTERNATIONAL
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
- Page Numbers: pp.819-824
- Keywords: pneumoperitoneum, nonsurgical pneumoperitoneum, spontaneous pneumoperitoneum, NONSURGICAL PNEUMOPERITONEUM, PNEUMATOSIS-INTESTINALIS, RARE CAUSE
- Inonu University Affiliated: Yes
Abstract
The presence of intraperitoneal free air signals perforation of a hollow viscus in over 90% of the patients. Rarely, however, the presence of pneumoperitoneum may not indicate an intra-abdominal perforation and thus may not require laparotomy. This condition, which poses a dilemma to the surgeon faced with this problem, is termed "nonsurgical", "spontaneous" or "idiopathic" pneumoperitoneum. Six cases of nonsurgical pneumoperitoneum admitted over a 2-year period to our institution are reported, and the etiological mechanisms and the pathophysiology of the appearance of intra-abdominal free gas are reviewed. Two of the six children with nonsurgical pneumoperitoneum underwent exploratory laparotomy when clinical examination suggested an acute abdomen; no intra-abdominal pathology was documented in one of these patients. In the other children, malrotation was found. Four patients, on ventilatory support, were managed conservatively after performing a diagnostic peritoneal lavage and/or contrast studies those were negative. An appreciation of the condition and its likely etiological factors should improve awareness and possibly reduce the imperative to perform emergency laparotomy on an otherwise well patient with an unexplained pneumoperitoneum.