Pneumoperitoneum

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ICD9 = , | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = radio | eMedicineTopic = 562 | MeshID = D011027 |

Description

Pneumoperitoneum is air or gas in the abdominal (peritoneal) cavity, often seen on x-ray, but small amounts are often missed and CT is nowadays regarded as a criterion standard in the assessment of a pneumoperitoneum., CT can visualize quantities as small as 5 cm³ of air or gas. The most common cause is a perforated abdominal viscus, generally a perforated ulcer, although any part of the bowel may perforate from a benign ulcer, tumor or trauma. A perforated appendix seldom causes a pneumoperitoneum.A pneumoperitoneum is deliberately created by the surgical team in order to perform laparoscopic surgery. This is achieved by insufflating the abdomen with carbon dioxide.

Causes

  • Perforated peptic ulcer
  • Bowel obstruction
  • Ruptured diverticulum
  • Penetrating trauma
  • Ruptured inflammatory bowel disease (e.g. megacolon)
  • Necrotising enterocolitis/Pneumatosis coli
  • Bowel Cancer
  • Ischemic bowel
  • Steroids
  • After laparotomy
  • After laparoscopy
  • Break down of a surgical anastomosis
  • Bowel injury after endoscopy
  • Peritoneal dialysis
  • Vaginal insufflation (air enters via the fallopian tubes, e.g. water-skiing, oral sex)
  • Colonic or peritoneal infection
  • From chest (e.g. bronchopleural fistula)
    • Subphrenic abscess, bowel interposed between diaphragm and liver (Chilaiditi syndrome), and linear atelectasis at the base of the lungs can simulate free air under the diaphragm on a chest x-ray.

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