Small Intestine: Pneumoperitoneum

Definition

• Definition: The Presence of Air/Gas in the Peritoneal Cavity
• The Majority (> 90%) are Due to Perforated Hollow Viscus

Post-Laparoscopic Resolution of Pneumoperitoneum

• Resolves within 3 Days in 81%
• Resolves within 7 Days in 96%

Causes

• Intraabdominal:
  • Perforated Viscera – Most Common Cause & Generally of the Most Immediate Concern
  • Intestinal Cystic Pneumatosis
  • Emphysematous Cholecystitis
  • Spontaneous Bacterial Peritonitis
  • Liver Pyogenic Abscess
• Intrathoracic:
  • Pneumothorax
  • Trauma
  • Broncho-Peritoneal Fistula
  • Pneumomediastinum
  • Pneumonia
  • Cardiopulmonary Resuscitation
  • Mechanical Ventilation
• Procedures:
  • Paracentesis
  • Peritoneal Dialysis
  • Peritoneal Lavage
  • Laparoscopy
  • Laparotomy
  • Pelvic Instrumentation
  • Endoscopic Examinations
• Gynecologic:
  • Uterine Rupture
  • Vaginal Douching
  • Pelvic Inflammatory Disease
  • Aggressive Sexual Intercourse
• Other:
  • Scuba Diving
  • Adenotonsillectomy
  • Dental Extraction
  • Idiopathic

Presentation

• Mostly Related to the Underlying Cause
• Variable & Nonspecific
• Abdominal Pain
• Abdominal Distention
• Nausea & Vomiting
• Changes in Bowel Habits

Diagnosis

• Based on Imaging (XR or CT)
• CT Can Predict the Site of Perforation with 86% Accuracy

Idiopathic Spontaneous Pneumoperitoneum (ISP)

• Rare with Only a Few Case Reports
  • No Good Defined Risk Factors
  • A Few Cases of Recurrence Noted
• May Consider Observation in an Asymptomatic Patient with No Signs of Peritonitis
• Extremely Difficult to Rule Out Perforated Viscera Outside of the OR