Pneumoperitoneum: A review of nonsurgical causes

Richard A. Mularski, Jeffrey M. Sippel, Molly Osborne

Research output: Contribution to journalArticle

142 Citations (Scopus)

Abstract

Objective: To review causes of nonsurgical pneumoperitoneum (NSP), identify nonsurgical etiologies, and guide conservative management where appropriate. Data Source: We conducted a computerized MEDLINE database search from 1970 to 1999 by using key words pneumoperitoneum and benign, nonsurgical, spontaneous, iatrogenic, barotrauma, pneumatosis, diaphragmatic defects, free air, mechanical ventilation, gynecologic, and pelvic. We identified 482 articles by using these keywords and reviewed all articles. Additional articles were identified and selectively reviewed by using key words laparotomy, laparoscopy, and complications. Study Selection: We reviewed all case reports and reviews of NSP, defined as pneumoperitoneum that was successfully managed by observation and supportive care alone or that required a nondiagnostic laparotomy. Data Synthesis: Each unique cause of nonsurgical pneumoperitoneum was recorded. When available, data on nondiagnostic exploratory laparotomies were noted. Case reports were organized by route of introduction of air into the abdominal cavity: abdominal, thoracic, gynecologic, and idiopathic. Conclusions: Most cases of NSP occurred as a procedural complication or as a complication of medical intervention. The most common abdominal etiology of NSP was retained postoperative air (prevalence 25% to 60%). NSP occurred frequently after peritoneal dialysis catheter placement (prevalence 10% to 34%) end after gastrointestinal endoscopic procedures (prevalence 0.3% to 25%, varying by procedure). The most common thoracic causes included mechanical ventilation, cardiopulmonary resuscitation, and pneumothorax. One hundred ninety-six case reports of NSP were recorded, of which 45 involved surgical exploration without evidence of perforated viscus. The clinician should maintain a high index of suspicion for nonsurgical causes of pneumoperitoneum and should recognize that conservative management may be indicated in many cases.

Original languageEnglish (US)
Pages (from-to)2638-2644
Number of pages7
JournalCritical Care Medicine
Volume28
Issue number7
StatePublished - 2000

Fingerprint

Pneumoperitoneum
Laparotomy
Air
Artificial Respiration
Thorax
Barotrauma
Viscera
Abdominal Cavity
Information Storage and Retrieval
Cardiopulmonary Resuscitation
Peritoneal Dialysis
Pneumothorax
MEDLINE
Laparoscopy
Catheters
Observation
Databases

Keywords

  • Barotrauma
  • Benign
  • Complications
  • Diaphagmatic defects
  • Free air
  • Gynecological
  • Iatrogenic
  • Laparoscopy
  • Laparotomy
  • Mechanical ventilation
  • Nonsurgical
  • Pneumat osis
  • Pneumoperitoneum
  • Spontaneous

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Mularski, R. A., Sippel, J. M., & Osborne, M. (2000). Pneumoperitoneum: A review of nonsurgical causes. Critical Care Medicine, 28(7), 2638-2644.

Pneumoperitoneum : A review of nonsurgical causes. / Mularski, Richard A.; Sippel, Jeffrey M.; Osborne, Molly.

In: Critical Care Medicine, Vol. 28, No. 7, 2000, p. 2638-2644.

Research output: Contribution to journalArticle

Mularski, RA, Sippel, JM & Osborne, M 2000, 'Pneumoperitoneum: A review of nonsurgical causes', Critical Care Medicine, vol. 28, no. 7, pp. 2638-2644.
Mularski, Richard A. ; Sippel, Jeffrey M. ; Osborne, Molly. / Pneumoperitoneum : A review of nonsurgical causes. In: Critical Care Medicine. 2000 ; Vol. 28, No. 7. pp. 2638-2644.
@article{08bba5177f4e4947bba2551d31b35578,
title = "Pneumoperitoneum: A review of nonsurgical causes",
abstract = "Objective: To review causes of nonsurgical pneumoperitoneum (NSP), identify nonsurgical etiologies, and guide conservative management where appropriate. Data Source: We conducted a computerized MEDLINE database search from 1970 to 1999 by using key words pneumoperitoneum and benign, nonsurgical, spontaneous, iatrogenic, barotrauma, pneumatosis, diaphragmatic defects, free air, mechanical ventilation, gynecologic, and pelvic. We identified 482 articles by using these keywords and reviewed all articles. Additional articles were identified and selectively reviewed by using key words laparotomy, laparoscopy, and complications. Study Selection: We reviewed all case reports and reviews of NSP, defined as pneumoperitoneum that was successfully managed by observation and supportive care alone or that required a nondiagnostic laparotomy. Data Synthesis: Each unique cause of nonsurgical pneumoperitoneum was recorded. When available, data on nondiagnostic exploratory laparotomies were noted. Case reports were organized by route of introduction of air into the abdominal cavity: abdominal, thoracic, gynecologic, and idiopathic. Conclusions: Most cases of NSP occurred as a procedural complication or as a complication of medical intervention. The most common abdominal etiology of NSP was retained postoperative air (prevalence 25{\%} to 60{\%}). NSP occurred frequently after peritoneal dialysis catheter placement (prevalence 10{\%} to 34{\%}) end after gastrointestinal endoscopic procedures (prevalence 0.3{\%} to 25{\%}, varying by procedure). The most common thoracic causes included mechanical ventilation, cardiopulmonary resuscitation, and pneumothorax. One hundred ninety-six case reports of NSP were recorded, of which 45 involved surgical exploration without evidence of perforated viscus. The clinician should maintain a high index of suspicion for nonsurgical causes of pneumoperitoneum and should recognize that conservative management may be indicated in many cases.",
keywords = "Barotrauma, Benign, Complications, Diaphagmatic defects, Free air, Gynecological, Iatrogenic, Laparoscopy, Laparotomy, Mechanical ventilation, Nonsurgical, Pneumat osis, Pneumoperitoneum, Spontaneous",
author = "Mularski, {Richard A.} and Sippel, {Jeffrey M.} and Molly Osborne",
year = "2000",
language = "English (US)",
volume = "28",
pages = "2638--2644",
journal = "Critical Care Medicine",
issn = "0090-3493",
publisher = "Lippincott Williams and Wilkins",
number = "7",

}

TY - JOUR

T1 - Pneumoperitoneum

T2 - A review of nonsurgical causes

AU - Mularski, Richard A.

AU - Sippel, Jeffrey M.

AU - Osborne, Molly

PY - 2000

Y1 - 2000

N2 - Objective: To review causes of nonsurgical pneumoperitoneum (NSP), identify nonsurgical etiologies, and guide conservative management where appropriate. Data Source: We conducted a computerized MEDLINE database search from 1970 to 1999 by using key words pneumoperitoneum and benign, nonsurgical, spontaneous, iatrogenic, barotrauma, pneumatosis, diaphragmatic defects, free air, mechanical ventilation, gynecologic, and pelvic. We identified 482 articles by using these keywords and reviewed all articles. Additional articles were identified and selectively reviewed by using key words laparotomy, laparoscopy, and complications. Study Selection: We reviewed all case reports and reviews of NSP, defined as pneumoperitoneum that was successfully managed by observation and supportive care alone or that required a nondiagnostic laparotomy. Data Synthesis: Each unique cause of nonsurgical pneumoperitoneum was recorded. When available, data on nondiagnostic exploratory laparotomies were noted. Case reports were organized by route of introduction of air into the abdominal cavity: abdominal, thoracic, gynecologic, and idiopathic. Conclusions: Most cases of NSP occurred as a procedural complication or as a complication of medical intervention. The most common abdominal etiology of NSP was retained postoperative air (prevalence 25% to 60%). NSP occurred frequently after peritoneal dialysis catheter placement (prevalence 10% to 34%) end after gastrointestinal endoscopic procedures (prevalence 0.3% to 25%, varying by procedure). The most common thoracic causes included mechanical ventilation, cardiopulmonary resuscitation, and pneumothorax. One hundred ninety-six case reports of NSP were recorded, of which 45 involved surgical exploration without evidence of perforated viscus. The clinician should maintain a high index of suspicion for nonsurgical causes of pneumoperitoneum and should recognize that conservative management may be indicated in many cases.

AB - Objective: To review causes of nonsurgical pneumoperitoneum (NSP), identify nonsurgical etiologies, and guide conservative management where appropriate. Data Source: We conducted a computerized MEDLINE database search from 1970 to 1999 by using key words pneumoperitoneum and benign, nonsurgical, spontaneous, iatrogenic, barotrauma, pneumatosis, diaphragmatic defects, free air, mechanical ventilation, gynecologic, and pelvic. We identified 482 articles by using these keywords and reviewed all articles. Additional articles were identified and selectively reviewed by using key words laparotomy, laparoscopy, and complications. Study Selection: We reviewed all case reports and reviews of NSP, defined as pneumoperitoneum that was successfully managed by observation and supportive care alone or that required a nondiagnostic laparotomy. Data Synthesis: Each unique cause of nonsurgical pneumoperitoneum was recorded. When available, data on nondiagnostic exploratory laparotomies were noted. Case reports were organized by route of introduction of air into the abdominal cavity: abdominal, thoracic, gynecologic, and idiopathic. Conclusions: Most cases of NSP occurred as a procedural complication or as a complication of medical intervention. The most common abdominal etiology of NSP was retained postoperative air (prevalence 25% to 60%). NSP occurred frequently after peritoneal dialysis catheter placement (prevalence 10% to 34%) end after gastrointestinal endoscopic procedures (prevalence 0.3% to 25%, varying by procedure). The most common thoracic causes included mechanical ventilation, cardiopulmonary resuscitation, and pneumothorax. One hundred ninety-six case reports of NSP were recorded, of which 45 involved surgical exploration without evidence of perforated viscus. The clinician should maintain a high index of suspicion for nonsurgical causes of pneumoperitoneum and should recognize that conservative management may be indicated in many cases.

KW - Barotrauma

KW - Benign

KW - Complications

KW - Diaphagmatic defects

KW - Free air

KW - Gynecological

KW - Iatrogenic

KW - Laparoscopy

KW - Laparotomy

KW - Mechanical ventilation

KW - Nonsurgical

KW - Pneumat osis

KW - Pneumoperitoneum

KW - Spontaneous

UR - http://www.scopus.com/inward/record.url?scp=0033865577&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033865577&partnerID=8YFLogxK

M3 - Article

C2 - 10921609

AN - SCOPUS:0033865577

VL - 28

SP - 2638

EP - 2644

JO - Critical Care Medicine

JF - Critical Care Medicine

SN - 0090-3493

IS - 7

ER -