Summary about Disease
Pneumoperitoneum refers to the presence of free air or gas within the peritoneal cavity (the space surrounding the abdominal organs). It is typically a serious condition, most often caused by a perforation of a hollow abdominal organ, such as the stomach, small intestine, or colon. However, it can also occur spontaneously or as a result of medical procedures.
Symptoms
Symptoms can vary depending on the cause and severity, but common signs include:
Sudden and severe abdominal pain
Abdominal tenderness and rigidity (a board-like abdomen)
Shoulder pain (referred pain due to diaphragmatic irritation)
Abdominal distension
Nausea and vomiting
Rapid heart rate
Shortness of breath
Fever
Signs of shock (e.g., low blood pressure, dizziness)
Causes
The most common causes are:
Perforated Viscus: A hole or rupture in a hollow abdominal organ (e.g., peptic ulcer perforation, diverticulitis, bowel obstruction with perforation, perforated appendicitis, colon cancer perforation).
Trauma: Blunt or penetrating abdominal trauma that damages an organ.
Post-Surgical: Air introduced during abdominal surgery. This is often minimal and resolves on its own, but sometimes can cause larger pneumoperitoneum.
Medical Procedures: Colonoscopy (rarely), endoscopy (rarely), peritoneal dialysis, or recent laparoscopy.
Spontaneous Pneumoperitoneum: Rare, may occur without any apparent cause. It is also known as idiopathic pneumoperitoneum. Sometimes associated with lung disease (pneumomediastinum).
Pneumatosis intestinalis: Where gas-filled cysts develop in the intestinal walls, and can lead to pneumoperitoneum.
Medicine Used
The main goal of treatment is addressing the underlying cause of the pneumoperitoneum. Medicine used may include:
Broad-spectrum antibiotics: To combat infection, especially in cases of perforation. Examples: Ceftriaxone, Metronidazole, Piperacillin-Tazobactam.
Pain relievers: To manage pain (e.g., opioids).
Proton pump inhibitors (PPIs): If a peptic ulcer is suspected as the cause.
Intravenous fluids: For hydration and to support blood pressure. Important Note: Treatment is primarily surgical. Medications are an adjunct to surgery and supportive care.
Is Communicable
Pneumoperitoneum itself is not communicable. It is not an infectious disease that can be transmitted from person to person.
Precautions
Precautions are related to preventing the underlying causes. This includes:
Prompt medical attention for abdominal pain: Especially if severe or accompanied by other symptoms like fever or vomiting.
Safe surgical practices: Proper technique during abdominal surgeries and procedures.
Cautious use of NSAIDs: These can increase the risk of peptic ulcers.
Healthy lifestyle: Diet and exercise can reduce risk of diverticulitis and other bowel problems.
Avoidance of abdominal trauma: Wear seatbelts, use protective gear in sports.
How long does an outbreak last?
Pneumoperitoneum is not an outbreak-related disease. Its duration depends on the underlying cause and how quickly it is diagnosed and treated. If it's due to a perforation, it will persist until the perforation is surgically repaired. If it's due to a minor procedure, it may resolve within days with observation alone. Delays in diagnosis and treatment can lead to serious complications and even death.
How is it diagnosed?
Physical Exam: Abdominal tenderness, rigidity, and guarding.
Imaging Studies:
X-ray: An abdominal X-ray, particularly an upright (standing) view, is often the first step. It can reveal free air under the diaphragm, which is a hallmark of pneumoperitoneum.
CT Scan: A CT scan of the abdomen is more sensitive than an X-ray and can detect smaller amounts of free air. It can also help identify the source of the perforation or other underlying causes.
Blood Tests: Complete blood count (CBC), electrolytes, kidney function tests, and liver function tests can help assess the patient's overall condition and rule out other causes of abdominal pain.
Sometimes Further Investigations: If the initial diagnosis is unclear, further investigations such as endoscopy or colonoscopy may be necessary after stabilization.
Timeline of Symptoms
The timeline of symptoms varies depending on the cause.
Perforated viscus: Symptoms usually develop suddenly and rapidly, with severe abdominal pain being the first and most prominent symptom. Other symptoms like fever, nausea, and vomiting may follow quickly.
Post-surgical: Symptoms may appear within a few hours to days after surgery, depending on the amount of air present and the patient's overall condition.
Spontaneous: The onset may be more gradual, making diagnosis more challenging.
Important Considerations
Pneumoperitoneum is a surgical emergency in most cases. Prompt diagnosis and treatment are crucial to prevent serious complications like sepsis, peritonitis, and death.
The underlying cause of the pneumoperitoneum must be identified and addressed to ensure successful treatment.
Patients with pneumoperitoneum often require intensive care monitoring and support.
Even small amounts of free air require investigation.
Not all pneumoperitoneum requires immediate surgery. In rare cases, observation may be warranted, particularly in post-surgical cases with minimal symptoms.