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Two cases of spontaneous pneumoperitoneum without peritonitis
1Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur.
The Medical Journal of Malaysia
|December 1, 1993
Summary
Spontaneous pneumoperitoneum without peritonitis is rare. Management depends on clinical suspicion; observation is advised if abdominal fluid analysis is negative and no visceral perforation is suspected.
Area of Science:
- Surgery
- Critical Care Medicine
Background:
- Spontaneous pneumoperitoneum without peritonitis is a rare clinical presentation.
- It presents a diagnostic and management dilemma for surgeons.
Observation:
- Two cases are presented: one from tracheal rupture during intubation, another from positive pressure ventilation barotrauma.
- Air passage occurred along great vessels (case 1) and through the diaphragm (case 2).
- Both patients had unrelated mortality.
Findings:
- Tracheal rupture and barotrauma are potential causes of pneumoperitoneum without peritonitis.
- Abdominal tap or lavage can aid diagnosis when visceral perforation is not suspected.
- Observation may be appropriate if diagnostic tests are negative.
Implications:
- This study highlights rare etiologies of pneumoperitoneum without peritonitis.
- It suggests a diagnostic algorithm involving clinical assessment and procedural intervention.
- Conservative management with observation is a viable option in select cases.