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Recurrent spontaneous pneumoperitoneum: A surgical dilemma
Polly Estridge1, Jacob A Akoh1
1Department of Surgery, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth PL6 8DH, United Kingdom.
International Journal of Surgery Case Reports
|December 25, 2016
Summary
Spontaneous pneumoperitoneum, or free air in the abdomen without perforation, can sometimes be managed conservatively. This case highlights that even with inflammatory markers, non-surgical treatment may suffice, but close monitoring is crucial.
Area of Science:
- Gastroenterology
- Surgical Case Reports
Background:
- Spontaneous pneumoperitoneum is defined as free air in the peritoneal cavity without iatrogenic causes or visceral perforation.
- Patients often present with signs of peritonism, including fever and elevated inflammatory markers, typically necessitating surgical intervention.
Purpose of the Study:
- To report a rare case of spontaneous pneumoperitoneum managed conservatively.
- To discuss the implications of conservative management in patients with elevated inflammatory markers.
Main Methods:
- A 36-year-old female patient with a history of Moyamoya disease, livedo reticularis, and peptic ulceration presented with recurrent pneumoperitoneum.
- Despite presenting with fever and raised inflammatory markers, the patient opted for conservative management, which proved successful without surgical intervention.
Main Results:
- The patient experienced spontaneous pneumoperitoneum on multiple occasions.
- Conservative management was successful in this case, despite the presence of inflammatory markers and fever, indicating no need for surgical exploration.
Conclusions:
- While surgical intervention is standard for spontaneous pneumoperitoneum with peritonism, conservative management may be considered in select cases.
- Clinical deterioration should guide the decision for surgical intervention in patients with spontaneous pneumoperitoneum.
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