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Spontaneous Pneumoperitoneum due to Constipation.

Ippei Yamana1, Tomoaki Noritomi1, Shinsuke Takeno1

  • 1Department of Gastroenterological Surgery, Fukuoka University School of Medicine, Fukuoka, Japan.

Case Reports in Gastroenterology
|December 18, 2015
PubMed
Summary

This study presents a rare case of spontaneous pneumoperitoneum in an elderly male with severe constipation. The condition, characterized by abdominal free air without clear perforation, was attributed to mucosal injury from internal pressure.

Keywords:
Abdominal painConstipationDifferentiationIntestinal cystic pneumatosisSpontaneous pneumoperitoneum

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Area of Science:

  • Gastroenterology
  • Surgical Case Reports

Background:

  • Spontaneous pneumoperitoneum is a rare condition characterized by the presence of free air in the abdominal cavity without a clear cause of gastrointestinal perforation.
  • Elderly patients with severe constipation are at risk for various abdominal complications.

Observation:

  • An 82-year-old Japanese male presented with constipation and abdominal pain.
  • Abdominal CT revealed significant fecal impaction and pneumoperitoneum.
  • Emergency laparotomy identified no definitive gastrointestinal perforation or ischemic changes.

Findings:

  • The patient was diagnosed with spontaneous pneumoperitoneum, likely secondary to increased intra-colonic pressure causing mucosal injury and subsequent air translocation.
  • No surgical intervention for perforation was required; conservative management of defecation was successful.

Implications:

  • This case highlights a rare etiology of pneumoperitoneum, emphasizing the need for thorough evaluation in cases of severe constipation and abdominal free air.
  • It suggests that non-perforative mucosal injury can lead to pneumoperitoneum, potentially avoiding unnecessary surgical intervention.