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Query: UMLS:C0000727 (acute abdomen)
 3,084 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pneumoperitoneum is usually the result of hollow viscus perforation with associated peritonitis. Nonsurgical spontaneous pneumoperitoneum incidental to intrathoracic, intra-abdominal, gynecologic, iatrogenic, and other miscellaneous causes not associated with perforated viscus have been documented in the literature. Seven cases of spontaneous pneumoperitoneum admitted over 3-year period to Grady Memorial Hospital, Atlanta, Georgia are reported. Six patients with pneumoperitoneum underwent exploratory laparotomy when clinical examination suggested an acute abdomen; no intra-abdominal pathology was documented in any of these patients. A seventh patient, on ventilatory support, was managed conservatively after performing a diagnostic peritoneal lavage that was negative. There were no cases of radiographically misdiagnosed pneumoperitoneum. Pneumoperitoneum, preceded by a reasonable incidental cause in a patient with a adequate abdominal examination, may warrant continued observation thus avoiding an unnecessary laparotomy.
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PMID:Spontaneous pneumoperitoneum. A surgical dilemma. 200 2

Plain radiography is the method of choice in suspected perforating pneumoperitoneum. Nevertheless, especially when air collections are small, the technique must be very accurate, with patient mobilization and long examination times, which may be unfeasible in acute abdomen patients. To overcome these limitations, such cross-sectional imaging methods as US and especially CT are increasingly used. Our series consisted of 38 patients with gastrointestinal tract perforation examined 1990-94; thirty-one of them had surgical confirmation. CT had high sensitivity, demonstrating the presence of free intraperitoneal gas in more patients than conventional radiography (92% vs. 74%). Pneumoperitoneum was depicted between liver surface and anterior abdominal wall in 30 cases, in the subhepatic region in 17, posterior to the abdominal wall at paraumbilical level in 14, between the mesenteric folds in 8, in the pelvis in 7 and in other locations in 11. Extraluminal fluid collections were apparent in 79% of cases and contrast agent collections in 73%. The three most common findings were: intraperitoneal gas, fluid effusion and extraluminal contrast agent leaks (61.5%), gas and effusion (29%) and gas only (16%). The origin of the perforation was demonstrated in 82% of cases and its cause in 37%. CT was particularly useful in the diagnosis of clinically occult, of early and of confined perforations. Small gas bubbles, mild fluid effusion or minimum contrast agent leaks near perforation site are valuable signs. In selected cases CT can play an integrative role, thus improving the diagnostic accuracy of plain films.
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PMID:[Computed tomography in the study of gastrointestinal perforation]. 862 38

Computed tomography (CT) is playing an increasingly greater role as the initial diagnostic imaging modality for acute abdomen. Abdominal pain is the most common presenting complaint for intestinal lymphoma, and acute abdomen is a not infrequent admitting complaint. We present the CT findings of five patients with intestinal lymphoma whose initial complaint was acute abdomen. Of these five patients, four had an identifiable mass that was located in the right lower quadrant, with the fifth patient having no identifiable mass on CT. The average mass size was 7.8 cm. Three of the patients showed involvement of the colon only, and two showed involvement of the small bowel only, with acute abdomen in only one of the patients with small-bowel involvement being due to direct extension from mesenteric lymph nodes. Pneumoperitoneum and free intraperitoneal fluid were seen in two patients. It is important, therefore, that the radiologist be aware that one of the causes of acute abdomen with primary bowel involvement is lymphoma, which can simulate appendicitis or diverticulitis in its presentation clinically and by physical examination.
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PMID:CT appearance of acute abdomen as initial presentation in lymphoma of the large and small bowel. 884 4

Pneumoperitoneum (PP) is usually the result of perforation of the gastrointestinal (GI) tract with associated peritonitis. However, other rare causes, including spontaneous PP incidental to intrathoracic, intra-abdominal, gynecologic, and miscellaneous other origins not associated with a perforated GI tract have been described in the literature. Six cases of PP without any perforated GI tract are reported. Three patients with generalized peritonitis underwent exploratory laparotomy or laparoscopy when clinical examinations suggested an acute abdomen. At surgical procedure, perforated pyometra, perforated liver abscess and a ruptured necrotic lesion of a liver metastasis were documented in these patients, respectively. We also saw 3 PP patients not associated with peritonitis. Two patients with PP caused by pneumatosis cystoides intestinalis were encountered, 1 was managed conservatively and the other received diagnostic laparoscopy. A patient in whom pneumomediastinum and pneumoretroperitoneum were accompanied by PP caused by an alveolar rupture based on decreased pulmonary compliance due to malnutrition was managed conservatively. The history of the patient and knowledge of the less frequent causes of PP can possibly contribute towards refraining from exploratory laparotomy in the absence of peritonitis.
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PMID:Pneumoperitoneum without perforation of the gastrointestinal tract. 1280 2

We encountered a case of pneumoperitoneum caused by a gas-forming splenic abscess in a patient with acquired immunodeficiency syndrome (AIDS). Plain abdominal films and computed tomography demonstrated a large amount of free air. Pneumoperitoneum was eventually shown to represent gas liberated from fermentation by gas-forming organisms within the splenic abscess. Gas-containing necrotic tissue from the ruptured spleen mimicked the spillage of feces from colon perforation. The authors emphasize that a ruptured abscess should be included in the differential diagnosis of acute abdomen in an immunocompromised patient.
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PMID:Ruptured splenic abscess: a cause of pneumoperitoneum in a patient with AIDS. 1529 May 9

Acute abdomen is an emergent condition in the emergency department, and it is mandatory to evaluate it immediately and treat it without delay. Pneumoperitoneum is usually attributed to perforation of the gastrointestinal tract. However, intra-abdominal, gynecologic, urologic, and miscellaneous pathogenesis not related to a perforated gastrointestinal tract had never been described in the past. Approximately 10% of pneumoperitoneum is not associated with hollow organ perforation. There are many imitators of pneumoperitoneum including subphrenic abscess, colon volvulus, Chilaiditi syndrome, and so on. In our case, the gas-forming bacterial peritonitis accounted for the pneumoperitoneum. We presented an 85-year-old man who received laparotomy due to peritonitis, and radiographic subphrenic free air was seen. However, a large amount of ascites was found rather than perforated bowels during the surgical exploration, and the culture of ascites was positive for Pseudomonas aeruginosa.
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PMID:Gas-forming bacterial peritonitis mimics hollow organ perforation. 1877 59

Pneumoperitoneum is often caused by visceral perforation, and usually manifests with symptoms of peritonitis requiring surgical intervention. Non-surgical spontaneous pneumoperitoneum (ie. not associated with organ perforation) is a rare entity due to intrathoracic, intra-abdominal, gynecologic, iatrogenic or other reasons, and is usually treated conservatively. Idiopathic spontaneous pneumoperitoneum is even rarer than visceral perforation or other causes of free intra-abdominal air. In this report, we present a case of idiopathic spontaneous pneumoperitoneum. A seventy-five-year-old female patient presented with acute abdominal pain, low-grade fever, and nausea. Her abdominal examination findings were vague, and she did not have leukocytosis. Free intra-abdominal air was detected on plain X-ray, she was followed-up with cessation of oral intake, nasogastric tube, fluid resuscitation and prophylactic antibiotics for one day. There were no signs of acute abdomen except diffuse abdominal tenderness by deep palpation on the first day examination. There was a mild leukocytosis with a shift to the left in leukocytes, and pneumoperitoneum on abdominal X-ray. The abdominal computed tomography revealed free intra-abdominal air and minimal free fluid in Douglas pouch. Her past medical history revealed cholecystectomy (10 years ago) with no chronic diseases, regular medications, smoking, or alcohol consumption. The patient underwent emergency laparotomy. Despite lack of an identifiable cause and uncertainty of etiology, the patient was discharged on postoperative day 5. A thorough medical history, appropriate laboratory tests and radiological techniques and physical examination should be combined for identification of patients with non-surgical pneumoperitoneum, and avoid unnecessary laparotomy, while minimally invasive techniques such as laparoscopy should be considered as part of evaluation.
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PMID:Spontaneous idiopathic pneumoperitoneum with acute abdomen. 2617 Jul 47

Pneumoperitoneum seen on an X-ray or computed tomography (CT) image points to a diagnosis of ruptured viscus and immediate surgery is warranted. A case of tubo-ovarian abscess (TOA) presenting with pneumoperitoneum is unusual. Very few cases have been reported where the pneumoperitoneum is caused by an abscess involving the adnexa. We present the case of a 17-year-old patient who presented with acute abdomen and raised inflammatory markers and had laparoscopy for suspected bowel perforation based on the finding of pneumoperitoneum on CT scan. Bowel perforation was ruled out and the findings were consistent with TOA. She had drainage of the abscess, subsequently received intravenous antibiotics and postoperatively recovered well. The pneumoperitoneum could have been due to coinfection with E. coli, as the patient had had a urinary tract infection due to E. coli three weeks before presentation, or slow leakage of the TOA. In conclusion, gas under the diaphragm can be related to non-bowel-related gynaecological pathology, but it vital to rule out sinister causes.
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PMID:Pneumoperitoneum secondary to tubo-ovarian abscess: A case report. 3208 93