Spontaneous idiopathic pneumoperitoneum with acute abdomen
Nidal Iflazoğlu1, Oruç Numan Gökçe1, Mefküre Mine Kıvrak1, Betül Kocamer2
1Clinic of General Surgery, Kilis State Hospital, Kilis, Turkey
2Clinic of Anesthesiology and Reanimation, Kilis State Hospital, Kilis, Turkey
Abstract
Pneumoperitoneum often occurs following a visceral perforation and is usually seen with peritonitis, requiring urgent surgical intervention. Non-surgical spontaneous pneumoperitoneum (not associated with organ perforation) is a rare situation caused by intrathoracic, intra-abdominal, gynaecologic, iatrogenic, and other reasons, and may be treated conservatively. Spontaneous idiopathic pneumoperitoneum is seen much less often than visceral perforation or other reasons causing intraabdominal gas. We present a case of idiopathic spontaneous pneumoperitoneum. A 75-year-old female patient applied with acute abdominal pain, subfebrile fever and nausea. Abdominal findings were not definitive, there was no leucocytosis but free intraabdominal air on the abdominal X-ray. The patient was observed for one day without oral feeding, nasogastric tubing, prophylactic antibiotics and saline infusion. At the first day of follow up she had only generalized abdominal pain on deep palpation, without other acute abdominal signs. She had mild leucosytosis, neutrophilia, and pneumoperitoneum on direct abdominal X-ray. On abdominal computerized tomography there was no pathologic sign other than intraabdominal free air and minimal free fluid in Douglas pouch. There was only a cholecystectomy (10 years ago) in her history, no chronic illness or other situation such as drug abuse, smoking or alcohol consumption. An emergency laparotomy was performed. Although no abdominal pathology could be found and the etiology could not be determined, the patient was discharged on the 5th postoperative day. Good patient history, appropriate laboratory tests, and radiologic tests combined with physical examination should be combined to avoid unnecessary laparotomy on non-surgical pneumoperitoneum, and minimally invasive techniques should also be considered.
Keywords: Idiopathic pneumoperitoneum, spontaneous pneumoperitoneum, acute abdomen
Written informed consent was obtained from patients who participated in this case.
Externally peer-reviewed.
Concept - N.İ., O.N.G.; Data Collection and/or Processing - N.İ., B.K.; Analysis and/or Interpretation - N.İ., M.N.K.; Writer - N.İ., O.N.G.
No conflict of interest was declared by the authors.
The authors declared that this study has received no financial support.