Pneumoperitoneum
Pneumoperitoneum | |
---|---|
hemidiaphragm (on the left of the image) is a pneumoperitoneum. | |
Specialty | Gastroenterology |
Pneumoperitoneum is
Spontaneous pneumoperitoneum is a rare case that is not caused by an abdominal organ rupture. This is also called an idiopathic spontaneous pneumoperitoneum when the cause is not known.
In the mid-twentieth century, an "artificial" pneumoperitoneum was sometimes intentionally administered as a treatment for a
Causes
- Perforated duodenal ulcer– The most common cause of rupture in the abdomen. Especially of the anterior aspect of the first part of the duodenum.
- Perforated peptic ulcer[1]
- Bowel obstruction[2][3]
- Ruptured diverticulum[4]
- Penetrating trauma[5]
- Ruptured inflammatory bowel disease (e.g., megacolon)[6]
- Necrotising enterocolitis/pneumatosis coli[7]
- Bowel cancer[8]
- Ischemic bowel[9][10][11]
- Steroids
- After laparotomy
- After laparoscopy
- Breakdown of a surgical anastomosis
- Bowel injury after endoscopy
- Peritoneal dialysis (PD), although the prevalence of pneumoperitoneum is estimated to be less than 4% among people with PD in a more recent study in the United Kingdom.[12]
- Vaginal insufflation (air enters via the )
- Colonic or peritoneal infection
- From chest (e.g., bronchopleural fistula)
- Non-invasive PAP (positive airway pressure) can force air down duodenum as well as down trachea.
Spontaneous pneumoperitoneum
A spontaneous pneumoperitoneum is a rare case that is not caused by an abdominal organ rupture. This is also called an idiopathic spontaneous pneumoperitoneum when the cause is not known.
Diagnosis
When present, pneumoperitoneum can often be seen on projectional radiography, but small amounts are often missed, and CT scan is nowadays regarded as a criterion standard in the assessment of a pneumoperitoneum.[18] CT can visualize quantities as small as 5 cm3 of air or gas.
Signs that can be seen on projectional radiography are shown below:
The double wall sign marks the presence of air on both sides of the
The football sign is when the abdomen appears as a large oval
The Cupola sign is seen when air is accumulated under the central tendon of the diaphragm.[23]
-
Another pneumoperitoneum on chest X-ray.
-
Pneumoperitoneum seen on X-ray with the patient lying on his left side.
-
Double wall sign. This is a secondary sign of pneumoperitoneum. Patient is supine, and air within the abdomen and lumen of the bowel accentuate both sides of the bowel wall.
-
Ultrasound finding of pneumoperitoneum known as "peritoneal stripe sign"[24]
Differential diagnosis
As differential diagnoses, a subphrenic abscess, bowel interposed between diaphragm and liver (Chilaiditi syndrome), and linear atelectasis at the base of the lungs can simulate free air under the diaphragm on a chest X-ray.[citation needed]
Treatment
Treatment depends on the cause of the condition.[citation needed]
Terminology
Pneumoperitoneum can be described as peritoneal emphysema,[25] just as pneumomediastinum can be called mediastinal emphysema, but pneumoperitoneum is the usual name.
See also
- Cupola sign
- Football sign
- Pneumoretroperitoneum
- Rigler's sign
References
- ^ "Peptic Ulcer Disease". The Lecturio Medical Concept Library. Retrieved 10 August 2021.
- ^ "Large Bowel Obstruction". The Lecturio Medical Concept Library. Retrieved 10 August 2021.
- ^ "Small Bowel Obstruction". The Lecturio Medical Concept Library. Retrieved 10 August 2021.
- ^ "diverticulum | Definition of diverticulum in English by Lexico Dictionaries". Lexico Dictionaries | English. Archived from the original on July 17, 2019. Retrieved 2019-07-17.
- ISBN 3-13-140331-4. Retrieved 2008-06-12.
- ^ "Megacolon". The Lecturio Medical Concept Library. Retrieved 10 August 2021.
- ^ Necrotizing Enterocolitis Bugs, Drugs and Things That Go Bump in the Night
- ^ "Colon Cancer Treatment (PDQ®)". NCI. May 12, 2014. Archived from the original on July 5, 2014. Retrieved June 29, 2014.
- S2CID 9575677.
- PMID 10784596.
- PMID 10784595. Archived from the originalon 2007-09-27.
- PMID 25984130.
- PMID 7369581.
Many injuries can result from water skiing accidents, but the water skiing "douche" is unique to this sport. Although generally causing only discomfort, significant trauma can result from the forceful entry of water into the various body orifices.
- PMID 11051188.
- PMID 24121052.
- PMID 8226082.
- PMID 1399374.
- ^ Khan AN, Chandramohan M (2017-12-06). Coombs BD, Gay SD (eds.). "Pneumoperitoneum Imaging". Emedicine, Medscape. WebMD LLC.
- PMID 10448501.
- PMID 872511.
- .
- PMID 14990817.
- PMID 26288798.
- ^ "UOTW #68 - Ultrasound of the Week". Ultrasound of the Week. 22 March 2016. Retrieved 27 May 2017.
- PMID 25803061.