Pneumoperitoneum
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Overview
| Pneumoperitoneum Classification and external resources | |
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| Frontal chest X-ray. The air bubble below the right hemidiaphragm (on the left of the image) is a pneumoperitoneum. | |
| ICD-10 | K66.8 |
| ICD-9 | 568.89, 770.2 |
| DiseasesDB | 31511 |
| eMedicine | radio/562 |
| MeSH | D011027 |
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US National Guidelines Clearinghouse on Pneumoperitoneum NICE Guidance on Pneumoperitoneum
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Pneumoperitoneum is air or gas in the abdominal (peritoneal) cavity[1], 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.[1], 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.
See also
References
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
