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Pneumoperitoneum After a Redo Cardiac Surgery: Patience Can Lead to Victory
Alfred Ibrahimi1, Selman Dumani2, Saimir Kuci1
1Anesthesiology, Mother Theresa University Hospital Center, Tirana, ALB.
Abstract:
Pneumoperitoneum after cardiac surgery is not usual. It occurs during extended sternotomy, which is sometimes accompanied by the opening of the peritoneal cavity or in cases after previous sternotomies. A 73-year-old man was operated on two times within one month due to prosthetic mitral valve dehiscence. The second operation was accompanied by a lot of complications, including blood loss, respiratory failure, massive pleural effusion, sternal infection, pneumomediastinum, and pneumoperitoneum. The presence of pneumoperitoneum alerted the possibility of intra-abdominal cavitary organ perforation. No surgical approach was chosen because there were no signs of peritonitis. The patient was discharged to home in a good health situation. Sixteen months later, he was recovered at the hospital for heart failure, and after abdominal CT, benign pneumoperitoneum was observed in the abdominal cavity again. There was no explanation for this finding, but again conservative treatment was chosen. He was discharged for the third time from the hospital in good condition.
Insights
Pneumoperitoneum, or air in the abdomen, is rare after cardiac surgery. This case study highlights a patient experiencing this unusual complication twice without signs of organ perforation, managed conservatively.
Area of Science:
- Cardiology
- Thoracic Surgery
- Abdominal Surgery
Background:
- Pneumoperitoneum is an uncommon complication following cardiac surgery, particularly after sternotomy or previous sternotomies.
- This case involves a 73-year-old male who underwent two cardiac surgeries within a month for prosthetic mitral valve dehiscence.
Observation:
- The patient experienced multiple complications during the second surgery, including pneumoperitoneum, alongside other issues like respiratory failure and sternal infection.
- Initial pneumoperitoneum raised concerns for intra-abdominal organ perforation, but the absence of peritonitis led to conservative management.
Findings:
- Despite initial conservative management, the patient was readmitted 16 months later for heart failure, with abdominal CT revealing recurrent benign pneumoperitoneum.
- No clear cause for the recurrent pneumoperitoneum was identified, and conservative treatment was again pursued.
Implications:
- This case underscores that pneumoperitoneum after cardiac surgery can be benign and may not necessitate surgical intervention, even when recurrent.
- Conservative management appears feasible for non-perforated pneumoperitoneum in post-cardiac surgery patients, even with repeat occurrences.
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