Spontaneous pneumoperitoneum without peritonitis is a rare phenomenon which poses a dilemma to the surgeons faced with this problem. Two such cases and their outcome are presented. The first case was caused by tracheal rupture during emergency intubation and was treated by observation until complete resolution. The second case was caused by barotrauma during positive pressure ventilation and was treated by laparotomy. Both patients died for reasons unrelated to the pneumoperitoneum. The passage of air from the chest cavity into the abdominal cavity was along the great vessels in the first case and through the diaphragm in the second. A compilation of other aetiologies of pneumoperitoneum without peritonitis as extracted from the literature is presented. In the presence of pneumoperitoneum without peritonitis and when the clinical history does not suggest visceral perforation, an abdominal tap or lavage should be attempted. If negative, continued observation is advised.
We describe a 50-year-old Chinese woman who had severe gastrointestinal manifestations from systemic sclerosis complicated by spontaneous pneumoperitoneum in the absence of either visceral perforation or pneumatosis cystoides intestinalis. This is a rare complication of systemic sclerosis; only four other cases have been reported. Recognition of this condition is important so as to avoid unnecessary surgery.
Barotrauma is a medical condition caused by sudden pressure changes in the body causing damage to multiple parts of the body. However, it is an infrequent occurrence when it comes to Colo-rectal perforation, wherein the trauma occurs due to the insufflation of compressed air through the anus. Several factors influence the outcome of a patient with colonic perforation due to barotrauma such as the severity of the injury, hemodynamic status of the patient, the patient's general health and well-being, the time taken for active medical/ surgical intervention since the injury, aggressive intravenous antibiotics administration to prevent sepsis, post-operative complications like surgical site infection, post-op ileus, anastomotic leak, etc. Overall, the patient's prognosis largely depends on early diagnosis, effective initial resuscitation, timely surgical intervention, and intensive post-operative care for a favorable outcome. Recently, we came across 2 cases of extensive pneumoperitoneum with Colo-rectal perforation as a result of the forceful insufflation of compressed air through the anus. Prompt medical intervention was necessary to prevent any further complications and they underwent surgical repair of the colorectal perforation.