A 70 years old male on ventilatory and circulatory support for sepsis and non ST segment elevation myocardial infarction developed abdominal distension 14 d after placement of a percutaneous endoscopic gastrostomy tub...A 70 years old male on ventilatory and circulatory support for sepsis and non ST segment elevation myocardial infarction developed abdominal distension 14 d after placement of a percutaneous endoscopic gastrostomy tube for enteral feeding.Radiography revealed free air in the abdomen and gastrograffin(G) study showed no extravasation into the peritoneum.The G tube was successfully repositioned with mechanical release of air.Imaging showed complete elimination of free air but the patient had a recurrence of pneumoperitoneum.Mechanical release of air with sealing of the abdominal wound was performed.Later,the patient was restarted on tube feeding with no complications.This case demonstrates a late complication of pneumoperitoneum with air leakage from the abdominal wall stoma.展开更多
Postoperative pneumoperitoneum poses a clinical dilemma.Depending on the cause,its management includes a spectrum from simple observation and supportive care to surgical exploration.The aim of this paper is to present...Postoperative pneumoperitoneum poses a clinical dilemma.Depending on the cause,its management includes a spectrum from simple observation and supportive care to surgical exploration.The aim of this paper is to present four clinical cases and propose an algorithm for the management of postoperative pneumoperitoneum based on available literature.The causes,diagnosis and possible complications arising from pneumoperitoneum will also be discussed.Three of the four cases presented were successfully managed conservatively and one had an exploratory laparotomy with negative findings.In such scenarios,it is important to consider the nonsurgical causes of pneumoperitoneum,which include pseudopneumoperitoneum,thoracic,abdominal,gynecological and idiopathic.These causes do not always require emergent exploratory laparotomy.The surgical team needs to consider the history,physical exam and diagnostic workup of the patient.If a patient presents with peritoneal signs,then exploratory laparotomy is a must.Since 10%of the cases of pneumoperitoneum are caused by nonsurgical entities,managed expectantly,a negative exploratory laparotomy and its associated risks are avoided.展开更多
文摘A 70 years old male on ventilatory and circulatory support for sepsis and non ST segment elevation myocardial infarction developed abdominal distension 14 d after placement of a percutaneous endoscopic gastrostomy tube for enteral feeding.Radiography revealed free air in the abdomen and gastrograffin(G) study showed no extravasation into the peritoneum.The G tube was successfully repositioned with mechanical release of air.Imaging showed complete elimination of free air but the patient had a recurrence of pneumoperitoneum.Mechanical release of air with sealing of the abdominal wound was performed.Later,the patient was restarted on tube feeding with no complications.This case demonstrates a late complication of pneumoperitoneum with air leakage from the abdominal wall stoma.
文摘Postoperative pneumoperitoneum poses a clinical dilemma.Depending on the cause,its management includes a spectrum from simple observation and supportive care to surgical exploration.The aim of this paper is to present four clinical cases and propose an algorithm for the management of postoperative pneumoperitoneum based on available literature.The causes,diagnosis and possible complications arising from pneumoperitoneum will also be discussed.Three of the four cases presented were successfully managed conservatively and one had an exploratory laparotomy with negative findings.In such scenarios,it is important to consider the nonsurgical causes of pneumoperitoneum,which include pseudopneumoperitoneum,thoracic,abdominal,gynecological and idiopathic.These causes do not always require emergent exploratory laparotomy.The surgical team needs to consider the history,physical exam and diagnostic workup of the patient.If a patient presents with peritoneal signs,then exploratory laparotomy is a must.Since 10%of the cases of pneumoperitoneum are caused by nonsurgical entities,managed expectantly,a negative exploratory laparotomy and its associated risks are avoided.
