Case Report
Volume 3 Issue 8 - 2020
Case Report of Negative Diagnostic Laparoscopy and EGD in a Patient with a Large Amount of Pneumoperitoneum
Jamesa Fabien, Yana Puckett* and Catherine Ronaghan
Department of Surgery, Texas Tech University Health Sciences Center, USA
*Corresponding Author: Yana Puckett, Department of Surgery, Texas Tech University Health Sciences Center, USA.
Received: May 09, 2020; Published: July 09, 2020




Abstract

We present the case of a 23-year-old male who presented with epigastrium and left upper quadrant pain. A computerized tomography (CT) scan of his abdomen and pelvis revealed a moderate amount of intraperitoneal free air; however, upon diagnostic laparoscopy and esophagogastroduodenoscopy no abnormalities were found.

The incidence of free air in the peritoneum is termed pneumoperitoneum. This is normally a result of perforation in the abdominal cavity. However, there are some rare cases as in the case of our patient in whom pneumoperitoneum is not due to perforation. Such cases are known as non-surgical or spontaneous pneumoperitoneum. Non-surgical pneumoperitoneum has a variety of causes including thoracic, abdominal, iatrogenic, gynecological, and traumatic causes. It is likely that our patient was a case of pseudo-pneumoperitoneum or of true idiopathic pneumoperitoneum.

To investigate the most common diagnostic methods for this rare disease we searched the PubMed database with the search term ‘spontaneous pneumoperitoneum’. CT scan was seen to be the most commonly used diagnostic method. However, studies show that laparoscopy is more sensitive and more specific than CT when it comes to ruling out bowel perforation. Laparoscopy has also been proven to be a safer diagnostic method than laparotomy as the former poses less adverse effects.

In cases like that of our patient, we recommend the use of laparoscopy to rule out bowel perforation. Additionally, when there are no signs of peritonitis, fever is absent, and white blood cell count is normal, conservative management is highly recommended. By acquiring a working knowledge of the wide array of potential causes of pneumoperitoneum and their mechanisms, unnecessary surgical exploration and its associated morbidity can be avoided.

Keywords: Computerized Tomography (CT); Emergency Department (ED); Nonsteroidal Anti-Inflammatory Drugs (NSAIDS)

References

  1. M Richard., et al. “Pneumoperitoneum: A review of nonsurgical causes”. Critical Care Medicine 7 (2000): 2638-2644.
  2. D NMA Williams. "Spontaneous pneumoperitoneum and other nonsurgical causes of intraperitoneal free gas”. Postgraduate Medical Journal 73 (1997): 531-537.
  3. MTLM Eric Goldberg. Pneumatosis intestinalis” (2019).
  4. BSM Singh., et al. “Chilaiditi’s sign, a cause of pseudo-pneumoperitoneum: A case report”. AGE Open Medical Case Reports 6 (2018): 2050313X18812213.
  5. , et al. "Idiopathic Spontaneous Pneumoperitoneum-Avoiding Laparotomy-A Case Report”. The Ulster Medical Journal 65.1 (1996): 84-86.
  6. H Nagar and A Kessler. "Spontaneous Pneumoperitoneum in a Healthy Adolescent”. Journal of Pediatric Gastroenterology and Nutrition 2 (1999): 220-221.
  7. Joanna C Law-Courter., et al. "A case of spontaneous pneumoperitoneum”. The American Journal of Emergency Medicine3 (2005): 398-399.
  8. “Idiopathic spontaneous pneumoperitoneum”. Image in Medicine 57 (2011).
  9. Michail Pitiakoudis., et al. "Spontaneous idiopathic pneumoperitoneum presenting as an acute abdomen: a case report”. Journal of Medical Case Reports 5 (2011): PMC3052194.
  10. Tung-Lung Wu., et al. "Spontaneous pneumoperitoneum: Report of one case”. Journal of Acute Medicine1 (2013).
  11. Nidal İflazoğlu., et al. "Spontaneous idiopathic pneumoperitoneum with acute abdomen”. Turkish Journal of Surgery2 (2013): 110-112.
  12. Rahul Gupta., et al. "Pneumoperitoneum in the Newborn: Is Surgical Intervention Always Indicated?”. Journal of Neonatal Surgery 3 (2014).
  13. TW Ryo Tanaka., et al. "Conservative treatment of idiopathic spontaneous pneumoperitoneum in a bedridden patient: a case report”. Surgical Case Reports1 (2015): 69.
  14. Ippei Yamana., et al. "Spontaneous Pneumoperitoneum due to Constipation”. Case Reports in Gastroenterology3 (2015): 361-365.
  15. Ryan T Lewinson., et al. "Spontaneous pneumoperitoneum with subcutaneous emphysema”. BMJ Case Reports (2016).
  16. T Ueda., et al. “Spontaneous pneumoperitoneum with duodenal diverticulosis in an elderly patient: a case report”. Surgical Case Reports1 (2020): 3.
  17. , et al. "Massive Pneumoperitoneum Presenting as an Incidental Finding”. Cureus 10 (2018).
  18. Enda Hannan., et al. "The clinical dilemma of the persistent idiopathic pneumoperitoneum: A case report”. International Journal of Surgery Case Reports 63 (2019): 10-12.
  19. , et al. "Spontaneous idiopathic pneumoperitoneum: about a case”. The Pan African Medical Journal 35.76 (2020).
  20. MW Jones., et al. “Bowel Perforation”. Stat Pearls Publishing (2020).
  21. Sung Hwan Kim., et al. "Gastrointestinal Tract Perforation: MDCT Findings according to the Perforation Sites”. Korean Journal of Radiology 10 (2009): 63-70.
  22. Pietro Addeo., et al. "Diagnostic and therapeutic value of laparoscopy for small bowel blunt injuries: A case report”. International Journal of Surgery Case Reports8 (2011): 316-318.
  23. Zoe Freeman Weiss., et al. "Pneumomediastinum in marijuana users: a retrospective review of 14 cases”. BMJ Open Respiratory Research1 (2019): PMC6424304.
Citation: Yana Puckett., et al. “Case Report of Negative Diagnostic Laparoscopy and EGD in a Patient with a Large Amount of Pneumoperitoneum”. EC Clinical and Medical Case Reports 3.8 (2020): 07-12.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


April Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the April issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for upcoming Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before April 22, 2021.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk