Cases reported "Pneumoperitoneum"

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1/14. Gastric perforation presenting as bilateral scrotal pneumatoceles.

    Although processus vaginalis is patent in the majority of newborn infants, the expression of an intraabdominal pathology such as gastrointestinal perforation or bleeding in the scrotum is very rare. In a large percentage of neonates with the gastrointestinal perforation, pneumoperitoneum is absent. In any case, it may not be detected in early radiographs. We report a newborn baby who presented with bilateral scrotal pneumatoceles as a first sign of pneumoperitoneum due to gastric perforation. Plain x-ray of the abdomen was normal except for pneumoscrotum, but contrast study revealed gastric perforation.
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2/14. pneumatosis cystoides intestinalis coli.

    The rare case of a 63-year-old male diagnosed with pneumatosis cystoides intestinalis coli is presented and discussed. The patient was found to have an unsymptomatic pneumoperitoneum on plain chest x-ray. The results of a contrast enema, computed tomography scan, and laparoscopy are presented. The patient had an uneventful hospital course without any specific therapy. Causes and possible therapeutic options are discussed.
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3/14. diagnosis of perforated gastric ulcers by ultrasound.

    patients with a perforation of the gastrointestinal tract need fast confirmation of diagnosis and early treatment to improve outcome. Plain abdominal x-ray does not always prove the perforation particularly at early stage. We report about a 62 year-old woman complaining of consistent abdominal pain with sudden onset. Ultrasound was taken as first diagnostic measure, revealing a perforation. The leakage was located in the stomach. radiography confirmed the pneumoperitoneum without indicating the perforated location. During operation the perforated gastric ulcer was found and sutured. This case report points out the reliability of ultrasound in diagnosing a pneumoperitoneum. Additionally it provides a summary of ultrasound signs seen in perforated gastric and duodenal ulcers and a review of literature.
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4/14. Gas embolism death after laparoscopy delayed by "trapping" in portal circulation.

    A young woman died suddenly about 1 hour after instillation of CO2 for diagnostic larparoscopy. Post-mortem x-rays revealed large volumes of gas in the portal system, the heart, and the brain. In addition, autopsy revealed gas bubbles in the coronary arteries, pulmonary hemorrhage and edema, and a probe-patent foramen ovale. We postulated the "trapping" of gas in the portal circulation and affirmed this by experiments in 6 dogs. We further postulate the delayed and intermittent release of this gas and of platelet aggregates into the systemic circulation would occur in volumes which would be insufficient to produce hemodynamic signs yet sufficient to produce serious pulmonary insult.
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5/14. Pneumomediastinum causing pneumoperitoneum.

    Pneumomediastinum is characterized by the presence of air in the mediastinum and has been recognized since 1827, when described by Laennec. To the best of our knowledge, pneumoperitoneum as a result of spontaneous pneumomediastinum has not yet been described in the English literature. We observed and treated a young patient in the intensive care unit who presented with spontaneous pneumomediastinum. Free intra-abdominal gas was observed on the chest x-ray film on the day after admission. Management was conservative. Intra-abdominal and mediastinal air disappeared within four days. This condition, when recognized, needs only observation; we report this as a medical curiosity.
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6/14. Intestinal injuries in childhood: analysis of 32 cases.

    This is a retrospective study of 32 cases of intestinal injuries sustained among 135 children admitted from cases of abdominal trauma in 1976 till 1989. Falls from height or bullock cart and bull-gore injury formed the majority of the cases (21/32; 65%). Clinical thermometer accounted for perforating injuries in 2 neonates. Penetrating injury accounted for 10 cases and blunt trauma was responsible in 19. The site of injury was duodenum 1, jejunum 8, ileum 17, colon 3, rectum 4, and multiple sites 1. Associated injuries included diaphragmatic rupture 1, liver 1, mesentery 4, retroperitoneal hematoma 4, head injury 2, and loss of hand due to blast 1. diagnosis was made on history, physical examination, pneumoperitoneum in plain x-ray, and diagnostic four-quadrant peritoneal tap. Closure of perforations was done in 21 cases, wedge resection in 3, and resection anastomosis in 5. Protective colostomy had to be done in 5 cases. Four patients died of septicemia (2) and head injury (2).
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7/14. intestinal perforation due to cytomegalovirus infection in patients with AIDS.

    intestinal perforation due to cytomegalovirus (CMV) infection in patients with AIDS is the most common life-threatening condition requiring emergency celiotomy in these patients. The authors describe a patient with AIDS with intestinal perforation due to CMV infection, and review 14 additional cases reported in the English-language surgical literature. The diagnostic triad of pneumoperitoneum on x-ray, evidence or history of CMV infection, and AIDS occurred in 70 percent of patients. The most common site of intestinal perforation was the colon (53 percent), followed in frequency by the distal ileum (40 percent) and appendix (7 percent); perforation usually occurred between the distal ileum and splenic flexure of the colon. colonoscopy, rather than sigmoidoscopy, is recommended as a screening examination in patients with AIDS suspected of having colonic ulceration due to CMV infection. Multiple biopsies of ulcerated tissue should be obtained. Gross and microscopic analyses of involved intestinal tissue reveal the characteristic findings of ulceration and CMV infection. Despite aggressive therapy, the operative mortality rate in patients with AIDS with intestinal perforation due to CMV infection was 54 percent and the overall mortality rate was 87 percent. postoperative complications occurred in most patients and consisted mainly of systemic sepsis and pneumonia caused by pneumocystis carinii infection. An increased awareness of this syndrome by physicians frequently called on to manage patients with AIDS is recommended.
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8/14. Free intra-peritoneal gas--an unusual aetiology.

    The presence of free gas under one or both hemidiaphragms on an erect chest x-ray is most frequently the result of recent abdominal surgery or, in the absence of such surgery, is almost always indicative of a perforated abdominal viscus. A case is reported of a patient in whom pneumoperitoneum was discovered incidentally on a chest x-ray following extensive pelvic manipulation for acute inversion of the uterus.
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9/14. air under the diaphragm in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).

    To understand the significance of pneumoperitoneum in patients undergoing continuous ambulatory peritoneal dialysis (CAPD), we reviewed 110 upright x-rays of 33 patients. Only 3 x-rays belonging to 2 patients displayed large amounts of air under the diaphragm. One patient had documented colonic perforation and the other patient used a faulty technique that introduced air into the abdomen. Five additional asymptomatic patients showed minute amounts of air. We conclude that large amounts of air, as defined radiographically by an air shadow of more than 5 mm in height, is unusual in CAPD patients and should be taken seriously as suggestive of bowel perforation until proven otherwise.
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10/14. Traumatic pneumoperitoneum following combined abdominal and thoracic injury.

    pneumoperitoneum following blunt abdominal trauma in the absence of other signs of severe intraabdominal injury is a rare finding. Although the vast majority of all cases of pneumoperitoneum are due to a ruptured intraabdominal hollow viscus, free abdominal air may result from significant barotrauma to the thorax. This type of secondary pneumoperitoneum can occur in the absence of chest x-ray evidence of a pneumothorax or pneumomediastinum. The complications associated with a missed visceral injury warrant an exploratory laparotomy, even if an extraabdominal source for the pneumoperitoneum is suspected.
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