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Pneumoperitoneum and its association with ruptured abdominal viscus
T G Winek1, H S Mosely, G Grout
1Department of Surgery, Good Samaritan Hospital, Portland, OR.
Abstract:
Pneumoperitoneum is not invariably associated with ruptured or perforated intra-abdominal viscus. To determine the incidence of free air associated with intra-abdominal viscus perforation, the medical records of 77 consecutive patients whose discharge or autopsy diagnosis included pneumoperitoneum or perforated viscus at a community hospital were retrospectively reviewed between June 1980 and October 1985. Abdominal viscus perforation, as determined by contrast studies or at operation, was not invariably associated with free air. Sixty-nine percent (23/33) of gastroduodenal, 30% (3/10) of small-bowel, and 37% (11/30) of large-bowel perforations had free air, as determined by preoperative x-ray film. Four cases with a total of six episodes of pneumoperitoneum were identified where viscus perforation was not documented. Pneumoperitoneum thus remains a reliable sign of viscus perforation; however, lack of this finding does not rule out perforation, and unusual causes must be considered.
Insights
Pneumoperitoneum, or free air in the abdomen, is a reliable indicator of perforated intra-abdominal viscus. However, its absence does not rule out perforation, necessitating consideration of other causes.
Area of Science:
- Gastroenterology
- Radiology
- Surgical Diagnosis
Background:
- Pneumoperitoneum is commonly associated with perforated intra-abdominal viscus.
- The diagnostic significance of free air in the abdomen requires further elucidation.
Purpose of the Study:
- To determine the incidence of free air in patients with intra-abdominal viscus perforation.
- To evaluate the reliability of pneumoperitoneum as a sign of viscus perforation.
Main Methods:
- Retrospective review of 77 patient records with discharge or autopsy diagnoses of pneumoperitoneum or perforated viscus.
- Analysis of preoperative X-ray findings for the presence of free air in relation to perforation site.
Main Results:
- Free air was detected in 69% of gastroduodenal, 30% of small-bowel, and 37% of large-bowel perforations.
- Four cases (six episodes) of pneumoperitoneum were identified without documented viscus perforation.
Conclusions:
- Pneumoperitoneum is a reliable sign of viscus perforation.
- Absence of free air does not exclude perforation; unusual causes should be considered.