Tension Pneumoperitoneum as a Result of Diastatic Perforation

Tension pneumoperitoneum is a vapid presentation of pneumoperitoneum, which generally refers to free air in the abdomen and can mimic abdominal compartment syndrome. A diastatic perforation in the abdomen refers to a perforation of the cecum due to a distal obstruction in the colon, manifesting as a closed-loop syndrome. We present a 46-year-old male diagnosed with obstructed left inguinal hernia who underwent hernioplasty. Postoperatively, the patient had progressive abdominal distention and abdominal pain. An abdominal x-ray and computed tomography of the abdomen showed massive air in the abdomen. The patient was diagnosed to have tension pneumoperitoneum. Needle decompression of the abdomen was done, and the patient underwent an emergency laparotomy. Intraoperatively, we found a large cecal perforation and a large amount of pneumoperitoneum. The patient underwent limited resection and ileostomy and ascending mucus fistula. Postoperatively, the patient had an uneventful course and was discharged.