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Postgraduate Medical Journal Sep 1997Intraperitoneal free gas seen radiologically as air under the diaphragm nearly always indicates a perforated abdominal viscus that requires surgical intervention.... (Review)
Review
Intraperitoneal free gas seen radiologically as air under the diaphragm nearly always indicates a perforated abdominal viscus that requires surgical intervention. Rarely, however, the presence of a pneumoperitoneum may not indicate an intra-abdominal perforation and thus may not require laparotomy. Such a situation is termed spontaneous or nonsurgical pneumoperitoneum. In this review, we explore the aetiological mechanisms and the pathophysiology of the appearance of intra-abdominal free gas. An appreciation of the condition and its likely aetiological factors should improve awareness and possibly reduce the imperative to perform an emergency laparotomy on an otherwise well patient with an unexplained pneumoperitoneum.
Topics: Child; Endoscopy, Gastrointestinal; Female; Genitalia, Female; Humans; Infant, Newborn; Pneumatosis Cystoides Intestinalis; Pneumoperitoneum; Positive-Pressure Respiration; Postoperative Complications; Radiography; Sepsis; Thoracic Injuries
PubMed: 9373590
DOI: 10.1136/pgmj.73.863.531 -
BMJ Case Reports Jan 2018A 35-year-old man stopped breathing after injecting a large dose of heroin. He subsequently received cardiopulmonary resuscitation from friends. He arrived to accident...
A 35-year-old man stopped breathing after injecting a large dose of heroin. He subsequently received cardiopulmonary resuscitation from friends. He arrived to accident and emergency department with Glasgow Coma Scale of 13. On examination, he had distended and tense abdomen. CT Thorax, Abdomen, and Pelvis confirmed massive tension pneumoperitoneum. A 14 Fr intravenous cannula was inserted through the umbilicus to relieve the intra-abdominal pressure. An emergency laparotomy showed petechia along the anterior gastric wall, haematoma of lesser omentum but showed no evidence of gastrointestinal perforation or organ injury. Air leak test performed by insufflating air into the stomach via nasogastric tube and abdomen filled with normal saline showed no leak. On-table oesophagogastroduodenoscopy showed mild oesophagitis and petechia of cardiac gastric mucosa. He was treated with intravenous antibiotics and discharged on the fifth postoperative day with adequate analgesia.
Topics: Abdominal Cavity; Adult; Analgesia; Anti-Bacterial Agents; Cannula; Cardiopulmonary Resuscitation; Decompression, Surgical; Drug Overdose; Heroin; Humans; Laparotomy; Male; Peritonitis; Pneumoperitoneum; Radiography, Abdominal; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 29386215
DOI: 10.1136/bcr-2017-223069 -
BMC Anesthesiology Dec 2022With recent advances in robot-assisted techniques, an increasing number of surgeries are being performed with pneumoperitoneum and head-down maneuver (HDM) that may...
BACKGROUND
With recent advances in robot-assisted techniques, an increasing number of surgeries are being performed with pneumoperitoneum and head-down maneuver (HDM) that may affect the cerebral microcirculation. For the first time, this study investigated the direct influence of pneumoperitoneum and HDM on the cerebral microvasculature in rabbits.
METHODS
Adult male rabbits were randomly allocated to the following groups (n = 7 each): control, pneumoperitoneum alone (P), and pneumoperitoneum with HDM (P + HDM) for 120 min. A closed cranial window was installed above the parietal bone to visualize the pial microvasculature. Pial arteriolar diameter and hemodynamic and blood gas parameters were measured during the 140-min observation period. Brain edema was assessed by evaluation of the brain water content at the end of the experiment.
RESULTS
Rabbits in the P and P + HDM groups exhibited a similar degree of immediate pial arteriolar dilation following the initiation of both P and P + HDM (P: 1.11 ± 0.03, p = 0.0044 and P + HDM: 1.07 ± 0.02, p = 0.0004, relative changes from the baseline value by defining the baseline as one). In the P + HDM group, pial arteriole diameter returned to the baseline level following the discontinuation of pneumoperitoneum and HDM (1.05 ± 0.03, p = 0.0906, vs. baseline). In contrast, the pial arterioles remained dilated as compared to the baseline level in the P group after discontinuation of pneumoperitoneum. There were no changes in pial arteriole diameter in the animals in the control group. Heart rate, blood gas parameters, and brain water content were not significantly different between the groups.
CONCLUSION
The pial arterioles dilated immediately after pneumoperitoneum with or without HDM. The pial arterioles remained dilated 20 min after discontinuation of pneumoperitoneum alone but constricted upon discontinuation of pneumoperitoneum plus HDM. Pneumoperitoneum and HDM for 2 h did not cause brain edema.
Topics: Male; Animals; Rabbits; Pneumoperitoneum; Brain Edema; Injections, Intraperitoneal; Microvessels; Microcirculation
PubMed: 36457106
DOI: 10.1186/s12871-022-01911-2 -
World Journal of Gastroenterology Jul 2022Pneumatosis intestinalis (PI) is defined as the presence of gas within the submucosal or subserosal layer of the gastrointestinal tract. It is a radiologic sign...
Pneumatosis intestinalis (PI) is defined as the presence of gas within the submucosal or subserosal layer of the gastrointestinal tract. It is a radiologic sign suspicious for bowel ischemia, hence non-viable bowel must be ruled out in patients with PI. However, up to 15% of cases with PI are not associated with bowel ischemia or acute abdomen. We described an asymptomatic patient with prednisolone-induced PI and modified the Naranjo score to aid in a surgeon's decision-making for emergency laparotomy non-operative management with serial assessment in patients who are immunocompromised due to long-term steroid use.
Topics: Humans; Ischemia; Laparotomy; Pneumatosis Cystoides Intestinalis; Pneumoperitoneum; Prednisolone
PubMed: 36161037
DOI: 10.3748/wjg.v28.i28.3739 -
BMJ Case Reports Nov 2018
Topics: Child, Preschool; Female; Herpesvirus 3, Human; Humans; Pneumonia; Pneumoperitoneum
PubMed: 30567138
DOI: 10.1136/bcr-2018-227397 -
The Cochrane Database of Systematic... Mar 2022This is the second update of a Cochrane Review first published in 2013 and last updated in 2017. Laparoscopic surgery is now widely performed to treat various abdominal... (Review)
Review
BACKGROUND
This is the second update of a Cochrane Review first published in 2013 and last updated in 2017. Laparoscopic surgery is now widely performed to treat various abdominal diseases. Currently, carbon dioxide is the most frequently used gas for insufflation of the abdominal cavity (pneumoperitoneum). Although carbon dioxide meets most of the requirements for pneumoperitoneum, the absorption of carbon dioxide may be associated with adverse events. Therefore, other gases have been introduced as alternatives to carbon dioxide for establishing pneumoperitoneum.
OBJECTIVES
To assess the safety, benefits, and harms of different gases (e.g. carbon dioxide, helium, argon, nitrogen, nitrous oxide, and room air) used for establishing pneumoperitoneum in participants undergoing laparoscopic abdominal or gynaecological pelvic surgery.
SEARCH METHODS
We searched CENTRAL, Ovid MEDLINE, Ovid Embase, four other databases, and three trials registers on 15 October 2021 together with reference checking, citation searching, and contact with study authors to identify additional studies.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) comparing different gases for establishing pneumoperitoneum in participants (irrespective of age, sex, or race) undergoing laparoscopic abdominal or gynaecological pelvic surgery under general anaesthesia.
DATA COLLECTION AND ANALYSIS
We used standard methodological procedures expected by Cochrane.
MAIN RESULTS
We included 10 RCTs, randomising 583 participants, comparing different gases for establishing pneumoperitoneum: nitrous oxide (four trials), helium (five trials), or room air (one trial) was compared to carbon dioxide. All the RCTs were single-centre studies. Four RCTs were conducted in the USA; two in Australia; one in China; one in Finland; one in Iran; and one in the Netherlands. The mean age of the participants ranged from 27.6 years to 49.0 years. Four trials randomised participants to nitrous oxide pneumoperitoneum (132 participants) or carbon dioxide pneumoperitoneum (128 participants). None of the trials was at low risk of bias. The evidence is very uncertain about the effects of nitrous oxide pneumoperitoneum compared to carbon dioxide pneumoperitoneum on cardiopulmonary complications (Peto odds ratio (OR) 2.62, 95% CI 0.78 to 8.85; 3 studies, 204 participants; very low-certainty evidence), or surgical morbidity (Peto OR 1.01, 95% CI 0.14 to 7.31; 3 studies, 207 participants; very low-certainty evidence). There were no serious adverse events related to either nitrous oxide or carbon dioxide pneumoperitoneum (4 studies, 260 participants; very low-certainty evidence). Four trials randomised participants to helium pneumoperitoneum (69 participants) or carbon dioxide pneumoperitoneum (75 participants) and one trial involving 33 participants did not state the number of participants in each group. None of the trials was at low risk of bias. The evidence is very uncertain about the effects of helium pneumoperitoneum compared to carbon dioxide pneumoperitoneum on cardiopulmonary complications (Peto OR 1.66, 95% CI 0.28 to 9.72; 3 studies, 128 participants; very low-certainty evidence), or surgical morbidity (5 studies, 177 participants; very low-certainty evidence). There were three serious adverse events (subcutaneous emphysema) related to helium pneumoperitoneum (3 studies, 128 participants; very low-certainty evidence). One trial randomised participants to room air pneumoperitoneum (70 participants) or carbon dioxide pneumoperitoneum (76 participants). The trial was at high risk of bias. There were no cardiopulmonary complications, serious adverse events, or deaths observed related to either room air or carbon dioxide pneumoperitoneum. AUTHORS' CONCLUSIONS: The evidence is very uncertain about the effects of nitrous oxide, helium, and room air pneumoperitoneum compared to carbon dioxide pneumoperitoneum on any of the primary outcomes, including cardiopulmonary complications, surgical morbidity, and serious adverse events. The safety of nitrous oxide, helium, and room air pneumoperitoneum has yet to be established, especially in people with high anaesthetic risk.
Topics: Adult; Carbon Dioxide; Helium; Humans; Insufflation; Laparoscopy; Nitrous Oxide; Pneumoperitoneum
PubMed: 35288930
DOI: 10.1002/14651858.CD009569.pub4 -
California Medicine Apr 1949Spontaneous pneumoperitoneum most often occurs following ruptured peptic ulcer. In 80 to 85 per cent of cases of perforated ulcers, free intraperitoneal air is...
Spontaneous pneumoperitoneum most often occurs following ruptured peptic ulcer. In 80 to 85 per cent of cases of perforated ulcers, free intraperitoneal air is demonstrable. There have been reported three cases in which air was present without demonstrable cause, without peritoneal irritation or peritonitis. This presentation adds a fourth. Examination of a patient with acute disease of the abdomen should include not only a roentgenogram with the patient supine but films made in the left lateral decubitus position and/or upright position to demonstrate free air. The radiologist should be ready and willing to consult with the surgeon at the time of examination. Attention is called to a sign described recently by Rigler in supine films, namely, the visibility of both the inside and the outside of the intestinal lumen. Another sign in the supine film, namely the contrast of air against the peritoneal reflections, is described.
Topics: Abdomen; Abdominal Cavity; Acute Disease; Humans; Injections, Intraperitoneal; Peptic Ulcer; Peritoneum; Peritonitis; Physical Examination; Pneumoperitoneum
PubMed: 18116231
DOI: No ID Found -
BMJ Case Reports Jan 2018
Topics: Abdominal Pain; Aged; Air; Back Pain; Chest Pain; Diagnosis, Differential; Diverticulitis; Female; Humans; Male; Megacolon, Toxic; Middle Aged; Pneumoperitoneum; Retropharyngeal Abscess; Tomography, X-Ray Computed
PubMed: 29326374
DOI: 10.1136/bcr-2017-223081 -
Asian Journal of Surgery Jun 2023
Topics: Humans; Retropneumoperitoneum; Pneumoperitoneum; Cystitis; Abdomen; Injections, Intraperitoneal; Emphysema
PubMed: 36635169
DOI: 10.1016/j.asjsur.2022.12.140 -
Revista Espanola de Enfermedades... Sep 2021We read with great interest the letter from Pérez Naranjo et al. regarding the case we recently published in this journal. We believe that the case presented by the...
We read with great interest the letter from Pérez Naranjo et al. regarding the case we recently published in this journal. We believe that the case presented by the authors is undoubtedly useful as it contributes to the scarce existing casuistry on the relationship between COVID-19 and the development of pneumatosis/pneumoperitoneum. We would like to emphasize the difficulty of determining the causality of this association due to the frequent co-occurrence of other causes that could justify the presence of pneumatosis/pneumoperitoneum.
Topics: COVID-19; Humans; Pneumatosis Cystoides Intestinalis; Pneumoperitoneum; SARS-CoV-2
PubMed: 33611919
DOI: 10.17235/reed.2021.7877/2021