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Pneumoperitoneum

Definition of Pneumoperitoneum

This is an abnormal state characterized by the presence of gas (air) in your peritoneal cavity, which is the area between the two membranes that separate the organs in your abdominal cavity from your abdominal wall. The peritoneal cavity is the largest smooth membrane sac in your body and secretes approximately fifty milliliters of fluid each day. This fluid has anti-inflammatory properties and acts as a lubricant.


Signs and Symptoms

Some of the symptoms that a person might feel or experience with pneumoperitoneum can include:

  • Abdominal pain
  • Tenderness in the abdominal area
  • Rigid abdomen
  • Severe epigastric pain
  • Absence of bowel sounds

In the cases of neonatal pneumoperitoneum you may symptoms such as:

  • Decrease in blood pressure
  • Distention of the abdomen
  • Blood gas levels deteriorating
  • Respiratory distress

There may also be symptoms that relate to what is causing pneumoperitoneum. If it is benign then it would asymptomatic.

Causes of Pneumoperitoneum

There are many different reasons that a person may develop air or gas inside their abdominal cavity.

  • One serious potential cause could be a perforation of your bowel or some other organ like what might happen if an abscess or ulcer ruptures
  • Infections with bacteria that generates gas as a byproduct
  • Sometimes gas or air can enter through the female reproductive tract
  • It can be a consequence of constipation
  • It can be iatrogenic, which means that it is caused by a surgical procedure or some other activity
  • During a laparoscopy procedure, which is where tools are inserted into your abdomen through little incisions to conduct surgery, air is deliberately introduced. Your abdomen is inflated with gas or air to make the surgical field easier and clearer to see. After surgery, the air or gas is expelled but usually not completely so you could have pneumoperitoneum for several weeks after having surgery. You would have this medical condition until the gas or air deposit is dispersed by your body
  • During a laparotomy, which is a surgical procedure that places a large incision in your abdominal wall to better access your abdominal cavity for any diseases of the abdominal cavity. During the procedure air or gas is also introduced just as in a laparoscopy causing the same results
  • Mouth-to-mouth ventilation
  • Cardiopulmonary resuscitation
  • Gynecologic examination

There is also another type of this medical condition called neonatal pneumoperitoneum, which has causes that are different from adult pneumoperitoneum. The primary cause for a newborn to have this medical condition is necrotizing enterocolitis, which is where portions of the bowel undergo tissue death. It is primarily seen in premature babies and is considered a medical emergency because it is a life-threatening condition if not treated immediately. Other causes of neonatal pneumoperitoneum can include:

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  • Hirschsprung disease—this is when the baby fails to pass meconium in the first one to two days after birth and accounts for fifteen to twenty percent of all intestinal obstructions in babies. Meconium is the baby’s first stool that has accumulated in their bowel during fetal life and is discharged shortly after they are born
  • Peptic ulcer disease
  • Rectal thermometer
  • Enema

There are also non-surgical causes of pneumoperitoneum, which include:

  • Penetrating trauma that can cause bowel injury or a rupture in your abdominal cavity
  • Malignancy such as bowel cancer
  • Perforation of your duodenal ulcer
  • Inflammatory bowel disease

Diagnosis

The pneumoperitoneum is normally diagnosed by using a medical imaging study, which can be an x-ray, but often with this type of medical imaging, small amounts are often missed. Today most imaging studies are done using CT scans, which stands for computed tomography. Using a CT scan, they can see quantities of gas or air as small as five centimeters. The size, location, and shape of the air or gas pocket can give important diagnostic clues.

Treatment

Depending on what the cause is, having pneumoperitoneum may not require aggressive treatment or it could be a sign of a medical emergency that would require immediate surgery to prevent any future complications. To find out what is causing pneumoperitoneum is the first step in finding what treatment, if any, is required.

Surgical vs Non-surgical Pneumoperitoneum

  • Surgical – if the medical condition is caused from a complication of a rupture or infection then you would need surgery to correct the problem as quickly as possible. If not it can lead to life-threatening medical emergencies.
  • Non surgical – in most cases of pneumoperitoneum the physician will use the conservative treatment, which is to take a wait and see approach to see if your body can eliminate the air or gas from your body on your own.

Complications

The main complication with pneumoperitoneum is developing an infection that can be a life-threatening condition. It requires immediate medical attention to help prevent the infection from spreading to other parts of your body.

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