The clinical dilemma of the persistent idiopathic pneumoperitoneum: A case report. (2019)

• Record Type: Journal Article
• Authors: Hannan, Enda; Saad, Eltaib; Hoashi, Shu; Toomey, Desmond
• Is Part Of: International journal of surgery case reports. Volume 63(2019)
• Page Start: 10
• Page End: 12
• Publication Date: 2019
• Subjects: Idiopathic -- Pneumoperitoneum -- Spontaneous -- Conservative -- Laparotomy -- Perforation; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2019.08.015
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Idiopathic pneumoperitoneum is a rare clinical entity that is challenging to identify and manage. Unneccessary surgical intervention in idiopathic pneumoperitoneum can lead to significant morbidity and even mortality. Conservative treatment with close observation is optimal if no peritonitis or radiological evidence of perforation. Contrast-enhanced CT may help exclude gastrointestinal perforation with 86% accuracy and thus help avoid unnecessary surgical intervention. Abstract: Introduction: Idiopathic pneumoperitoneum (IP) is a rare phenomenon which merits special attention. It is defined as free intraperitoneal air which is not caused by viscus perforation and does not require surgical intervention. It is generally considered a diagnosis of exclusion and often poses a genuine diagnostic dilemma. Presentation of case: We present an unusual case of persistent pneumoperitoneum with no identifiable cause which was found incidentally on a computed tomography (CT) scan in a patient with chronic cough and no prior surgical history. Serial consults revealed no abdominal symptoms or signs. He was managed conservatively and remains asymptomatic despite having a persistent IP on serial radiology. Discussion: To our knowledge, our case is the first in the literature of an idiopathic pneumoperitoneum that persisted on subsequent radiology and was managed successfully without surgical intervention. This is a highly important case for all practicing general surgeons to learn from as knowledge of this phenomenom may help avoid unnecessary surgical intervention and potential morbidities associated with this. Conclusion: IP is a diagnosis of exclusion which should only be made after surgical and non-surgical causes have been outruled. In the absence of signs of peritonitis and evidence of gastrointestinal perforation on CT, a conservative approach is warranted, allowing patients to avoid unnecessary surgical intervention.