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Query: UMLS:C0034067 (emphysema)
 11,506 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pneumoperitoneum, pneumomediastinum, pneumopericardium and subcutaneous emphysema developed in a patient following simple dental extraction. Other causes of this unusual complication, such as pneumatosis cystoides intestinalis, insufflation of fallopian tubes, pulmonary-peritoneal fistula, post-partum knee-chest exercises, laparotomy, paracentesis and peritoneal dialysis should be considered when peritoneal signs are absent so that unnecessary laparotomy can be avoided.
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PMID:Pneumoperitoneum, pneumomediastinum and pneumopericardium following dental extraction. 112 60

Experience gained in performing 3615 laparoscopic sterilizations in India over a 10-year period is reported. A simplified technique was developed for performing sterilization under local anesthesia without neuroleptanalgesia, avoiding uterine manipulators, performing direct trocar insertion without prior pneumoperitoneum, and using air for pneumoperitoneum. Beginning in 1973 laparoscopic sterilizations were performed using monopolar electrocoagulation and Hulka clips. The first 100 cases were done under local anesthesia with neuroleptanalgesia (75 mg meperidine, .6 mg atropine intravenously), using uterine manipulators and creating pneumoperitoneum with a Cerres needle and CO2. In 1974, neuroleptanalgesia was no longer used and air was used instead of CO2 for penumoperitoneum (3515 cases). The patients did not fast but were allowed to have liquids and given a glucose drink just prior to survery. The air was insufflated with a sigmoidoscopy bulb or a fish tank minicompressor. Since 1977 the trocar cannula has been inserted directly, without creating a pneumoperitoneum (1035 cases). Since 1980 the semilithotomy position and uterine manipulators are no longer used. A simple supine position with knees bent at right angles and a 30 degree Trendelenburg position was used in the last 435 cases. Of the 3515 cases performed under local anesthesia without neuroleptanalgesia, only 12 (.34%) needed medication during surgery. 20 patients developed vasovagal attacks and required atropine. None needed general anesthesia. Of the 3515 cases in which air was used for pneumoperitoneum, none developed air embolism. When preperitoneal (8 cases), omental (3 cases), and mediastinal (1 case) emphysema developed, it took 3-4 days to subside because the air was absorbed slowly. Postoperative shoulder pain persisted in 1038 cases (29.5%), but it was more of an annoyance than a complication. Of the 1035 cases of direct trocar insertion, there was no injury to the bowel or a blood vessel. In 14 cases (1.3%) the trocar was found to be extraperitoneal and reinserted for correct placement. Pneumoperitoneum with a Verres or spinal needle was created in 21 technically difficult cases (2%), which included obesity, previous scars, and a bulky postpartum uterus. A uterine manipulator wwas used in 9 technically difficult cases (2.07%).
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PMID:Development of a simplified laparoscopic sterilization technique. 623 98

Pneumoperitoneum is most commonly caused by the perforation of a hollow viscus, in which case an emergency laparotomy is indicated. We report herein the case of a patient who presented with the signs and symptoms of peritonitis, but who was found to have idiopathic pneumoperitoneum which was successfully managed by conservative treatment. A 70-year-old man presented with epigastric pain, nausea, and a severely distended and tympanitic abdomen. Abdominal examination revealed diffuse tenderness with guarding, but no rebound tenderness. He was febrile with leukocytosis and high C-reactive protein. Chest X-ray and abdominal computed tomography demonstrated a massive pneumoperitoneum without pneumothorax, pneumomediastinum, pneumoretroperitoneum, or subcutaneous emphysema, and subsequent examinations failed to demonstrate perforation of a hollow viscus. Thus, a diagnosis of idiopathic pneumoperitoneum was made, and the patient was managed conservatively, which resulted in a successful outcome. This experience and a review of the literature suggest that idiopathic pneumoperitoneum is amenable to conservative management, even when the signs and symptoms of peritonitis are present.
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PMID:Conservative management of idiopathic pneumoperitoneum masquerading as peritonitis: report of a case. 764 Apr 58

Pneumoperitoneum usually indicates rupture of a hollow viscus and considered a surgical emergency. But air may also enter the peritoneum from the lung or the genital organs in female without visceral perforation. While scuba diving, the rapid ascent is usually controlled by placing in a decompression chamber and the excess gas volume is exhaled. Failure to allow this excess gas to escape will result in overdistension of air passage, which may rupture resulting in pulmonary interstitial emphysema or, if air enters the circulation, air embolus can occur. Pneumo-peritoneum is a rare complication of diving accidents. While the majority of cases are not related to an intraabdominal catastrophy, more than 20% have been the result of gastric rupture. We report a 42-yr-old male patient with massive pneumoperitoneum after scuba diving, who presented himself with dyspnea and abdominal distension. Knowledge of this rare condition and its benign course may allow the emergency physician and surgeon to order appropriate studies to help avoid unnecessary surgical treatment. It is important to determine promptly whether the air emanated from a ruptured viscus or was introduced from an extraperitoneal source. Free air in the abdomen does not always indicate a ruptured intra-abdominal viscus.
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PMID:Massive pneumoperitoneum after scuba diving. 1269 30

Pneumoperitoneum in a preterm neonate usually indicates perforation of the intestine and is considered a surgical emergency. However, there are cases of pneumoperitoneum with no evidence of rupture of the intestine reported in the literature. We report a case of pneumoperitoneum with no intestinal perforation in a preterm neonate with respiratory distress syndrome who was on high frequency oscillatory ventilation (HFOV). He developed bilateral pulmonary interstitial emphysema with localized cystic lesion, likely localized pulmonary interstitial emphysema, and recurrent pneumothoraces. He was treated with dexamethasone to wean from the ventilator. Pneumoperitoneum developed in association with left sided pneumothorax following mechanical ventilation and cardiopulmonary resuscitation. Pneumoperitoneum resolved after the pneumothorax was resolved with chest tube drainage. He died from acute cardiorespiratory failure. At autopsy, there was no evidence of intestinal perforation. This case highlights the fact that pneumoperitoneum can develop secondary to pneumothorax and does not always indicate intestinal perforation or require exploratory laparotomy.
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PMID:Pneumoperitoneum without Intestinal Perforation in a Neonate: Case Report and Literature Review. 2856 20

Pneumoperitoneum in preterm infants is a surgical emergency as it is usually indicative of intestinal perforation. Rare cases of idiopathic pneumoperitoneum have been described in the literature, the underlying causes and pathophysiology of which remain uncertain. We present a case of pneumoperitoneum in an extremely preterm infant with severe growth restriction. This occurred while she was receiving high frequency oscillatory ventilation. She had respiratory distress syndrome with pulmonary interstitial emphysema. The pneumoperitoneum occurred in isolation. Despite the insertion of two surgical drains and two exploratory laparotomies in which no obvious intestinal perforation was noted, the free air in the abdomen reaccumulated. A decision was made to manage it conservatively. She was successfully extubated on the fourth week of life and the pneumoperitoneum resolved spontaneously. She was discharged home on day 136 of life. This case highlights our limited understanding of the intricate physiology of extremely low birthweight preterm neonates.
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PMID:Pneumoperitoneum in a neonate weighing less than 500 g. What do we really know about it? 2976 90