Symptoms, Causes, Treatment, and Complications of Pneumoperitoneum
What is Pneumoperitoneum?
Pneumoperitoneum is a condition characterized by the presence of free gas or air within the peritoneal cavity. The incidence of pneumoperitoneum is mostly implicated on the perforation that occurs in the abdominal viscera. A perforation in any part of the bowel may also perforate as a result of benign ulcer, trauma or a tumor and cause pneumoperitoneum as except for a perforation in the appendix that rarely causes pneumoperitoneum. Pneumoperitoneum on the other hand does not necessarily mean a perforation as various non-surgical conditions are also associated with the presence of gas in the abdominal cavity.
In medical imaging, a CT scan is mostly utilized and as a criterion for standardized assessment of pneumoperitoneum due to its property to visualize air or gas in the abdominal cavity as small as 5cm in size. X-ray can also be used to determine pneumoperitoneum although it usually misses small amounts of gas that CT scan is preferred.
Pneumoperitoneum may also occur as a result of an artificial introduction of gas in the peritoneal cavity during a surgical procedure known as surgical laparoscopy. This is mostly done by inflating the abdomen with the deliberate introduction of gas to provide a clearer surgical field. Most gas that are deliberately introduced usually expel after surgery although not all gas are being expelled and a few amounts are left which leaves patients with pneumoperitoneum for a few days or weeks post operation.
People in all age groups may be affected with pneumoperitoneum while infants and newborns are also at risked for pneumoperitoneum is termed as "neonatal pneumoperitoneum". The cause of pneumoperitoneum in neonate however is different from the cause of pneumoperitoneum in adults. Necrotizing enterocolitis is the primary cause of gas in the peritoneal cavity among newborns and is regarded as a medical emergency due to its life-threatening potential if not attended immediately.
The clinical presentation of pneumoperitoneum depends on the cause and benign causes are usually asymptomatic. In benign cause although asymptomatic, a vague abdominal pain may be experienced by the patient.
Pneumoperitoneum that resulted from a perforation in the abdominal viscera usually manifests with symptoms depending on the subsequent development of the condition. Abdominal pain and abdominal tenderness are common symptoms that are caused by buildup of air or free gas in the peritoneal cavity. Rigid abdomen, absence of bowel sounds and severe epigastric pain are also among the clinical presentation of pneumoperitoneum among adults and which have been caused by various perforations in any part of the peritoneal cavity and involvement of various organs of the body.
Neonatal pneumoperitoneum is regarded as a medical emergency. The presence of pneumoperitoneum in the neonate may be presented with distention of the abdomen, blood gas levels that is rather deteriorating, a decrease in the blood pressure and a respiratory distress. The clinical presentation of pneumoperitoneum should warrant enough to seek an immediate medical attention due to the life-threatening potential of the condition if not immediately attended.
Pneumoperitoneum involves the abdominal cavity or the peritoneal cavity particularly the abdominal viscera where a perforation is potential enough to cause free gas within the abdominal cavity. A perforation in any part of the bowel is also potential for pneumoperitoneum except the perforation of the appendix which seldom results in a collection of free gas within the abdominal cavity. Not all perforation however implies pneumoperitoneum. Various non-surgical conditions can also result in the presence of pneumoperitoneum.
Pneumoperitoneum may be Iatrogenic in nature or which that results from surgical procedures and other medical procedures or activity such as:
Laparoscopy is a surgical procedure intended for the abdomen or pelvis and which is performed with the use of a telescopic rod lens or a digital laparoscope that passes through the small incision made. Air retention is common post operative in which patient usually suffers from pneumoperitoneum for several weeks.
Laparotomy is a surgical procedure that places a large incision in the abdominal wall to access the abdominal cavity. It is intended as a primary procedure for therapy of peptic ulcer and other identified cause of the disease involving the abdominal cavity. A free gas or air is deliberately introduced during the procedure to provide a clearer visual of the abdominal cavity. The air is usually expelled post operatively although the incidence of air retention is common which causes pneumoperitoneum.
Cardiopulmonary resuscitation and mouth-to-mouth ventilation are also considered to cause the air to collect in the abdominal cavity.
Peritoneal dialysis is a less expensive alternative to hemodialysis intended for severe chronic kidney disease patients. The treatment introduces fluid with other dissolved substances through a permanent tube inserted into the abdomen.
Gynecologic examination procedure can also cause pneumoperitoneum where the air can enter via the fallopian tubes.
Nonsurgical causes of pneumoperitoneum include the following:
Perforation of the duodenal ulcer is the most common cause of a rupture in the abdominal cavity that can lead to pneumoperitoneum.
Necrotizing enterocolitis is the most common cause of pneumoperitoneum among newborn babies or neonates.
Penetrating trauma which can cause a rupture in the abdominal cavity or cause bowel injury is potential for pneumoperitoneum.
Inflammatory bowel disease which has become ruptured is also another factor considered to cause a collection of air within the peritoneal cavity.
Malignancy such as Bowel cancer can cause pneumoperitoneum when a perforation occurs or collection of free gas may also happen during diagnostic procedures and other therapeutic treatment.
The treatment and prognosis of pneumoperitoneum depend on its cause. The initial step of treatment is identifying the underlying condition that causes the air retention within the peritoneal cavity.
Air is usually expelled from the body after a surgical procedure although a small amount of air may be retained in the abdominal cavity which can linger for several weeks until dispersed by the body. A conservative approach is usually done by doctors where they usually wait until the body dispels the gas from the body.
Gas that collected within the peritoneal cavity and remains to linger for longer despite a conservative approach may need a surgical procedure to correct the condition.
Non-conservative or invasive approach is immediately required if pneumoperitoneum resulted from a perforation. The surgical requirement should be immediate as perforation is potentially life-threatening.
Pneumoperitoneum may occur as a result of perforation in any organ or part of the body. This is usually a medical complication that may arise with pneumoperitoneum although not all pneumoperitoneum implies a perforation. The immediate medical attention should be applied as fast as possible to counteract the danger of perforation.
Infection is also another possible complication that may occur with pneumoperitoneum which is also potentially life-threatening. Immediate medical attention is also necessary to prevent the infection from spreading to other parts of the body which may be fatal to the patient.