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Pneumoperitoneum complicating mechanical ventilator therapy.

W W Turner, W J Fry

    Archives of Surgery (Chicago, Ill. : 1960)
    |June 1, 1977
    PubMed
    Summary
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    Subdiaphragmatic air in ventilated patients can mimic perforated viscera. This study highlights retroperitoneal air dissection as a cause, emphasizing diagnostic tools like contrast roentgenography and peritoneal lavage.

    Area of Science:

    • Medical Imaging
    • Gastroenterology
    • Critical Care Medicine

    Background:

    • Subdiaphragmatic air typically suggests a perforated intra-abdominal viscus, a surgical emergency.
    • Mechanical ventilation can lead to air dissecting from the mediastinum into the retroperitoneum.
    • This retroperitoneal air can radiologically mimic subdiaphragmatic emphysema.

    Observation:

    • Four patients with respiratory failure on mechanical ventilation presented with radiologic evidence of subdiaphragmatic air.
    • Three patients initially suspected of perforated gastric or duodenal ulcers did not undergo surgery.
    • Autopsies in two patients revealed extraperitoneal subdiaphragmatic emphysema with secondary peritoneal rupture.

    Findings:

    • Retroperitoneal air dissection from the mediastinum is a potential cause of subdiaphragmatic air in ventilated patients.

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  • In some cases, extraperitoneal subdiaphragmatic emphysema can lead to secondary rupture into the peritoneal cavity.
  • Diagnostic challenges exist in differentiating this entity from actual visceral perforation.

    • Implications:

    • Accurate diagnosis is crucial to avoid unnecessary surgery in patients with mechanical ventilation.
    • Upper gastrointestinal contrast roentgenography and peritoneal lavage are valuable diagnostic tools.
    • Understanding this phenomenon improves patient management and diagnostic accuracy in critical care settings.