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Avoiding laparotomy in nonsurgical pneumoperitoneum.

Authors
  • Hoover, E L
  • Cole, G D
  • Mitchell, L S
  • Adams, C Z Jr
  • Hassett, J
Type
Published Article
Journal
The American Journal of Surgery
Publisher
Elsevier
Publication Date
Aug 01, 1992
Volume
164
Issue
2
Pages
99–103
Identifiers
PMID: 1636904
Source
Medline
License
Unknown

Abstract

Patients with free intraperitoneal air collections usually undergo emergency surgery, and the majority will have a gastrointestinal tract perforation. However, there is a subset of patients in whom no identifiable perforation is found at surgery. This entity of noniatrogenic, nonsurgical spontaneous pneumoperitoneum is being diagnosed more frequently at present and is commonly associated with other disease processes that, together, may suggest a benign process. Therefore, a diagnostic algorithm that would preclude operative intervention in this cohort of patients would be of paramount clinical importance. In this report, we present representative cases of the most common types of nonsurgical pneumoperitoneum, review the pathogenesis of this disorder, and discuss its relationship with pneumatosis cystoides intestinalis, pulmonary disorders, scleroderma, and gynecologic processes. Finally, we outline a diagnostic algorithm that may identify patients who can safely be observed, thereby reducing the incidence of negative laparotomies and, secondarily, the aggregate cost of health care.

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