Cases reported "Pneumoperitoneum"

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11/14. pneumatosis cystoides intestinalis with pneumoperitoneum in renal transplant patients on cyclosporine and prednisone.

    pneumatosis cystoides intestinalis has been detected in 3/103 kidney transplant patients (3%) treated with CsA and prednisone, in contrast to less than 1% of kidney transplant patients treated with Aza and prednisone. In these three patients, the diagnosis of PCI was made by plain x-rays, 10 to 25 days after transplantation. PCI may be more likely to occur in patients with CsA trough blood levels above the recommended therapeutic range. There was associated pneumoperitoneum in all three patients, but none were subjected to exploratory laparotomy. PCI and associated pneumoperitoneum were not associated with adverse effects in any of our three patients. Antibiotics and exploratory laparotomy appear to be unnecessary.
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12/14. Spontaneous gastric rupture in the newborn.

    Spontaneous rupture of the stomach during the neonatal period is the most common type of nonobstructive perforation. The clinical manifestations include severe abdominal distension, vomiting, and respiratory distress. However, diagnosis is based on an upright x-ray film of the abdomen which shows the "saddle" of "football" sign due to massive pneumoperitoneum. The fatality rate is still quite high. Success in treatment depends on early diagnosis and immediate surgical intervention.
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13/14. meconium peritonitis-observations in 115 cases and antenatal diagnosis.

    In 20 years the authors have met with 115 cases of meconium peritonitis (MP). The high incidence in china is shown. In all cases there were intraabdominal calcifications. There were no cases of fibrocystic disease. The authors classify 3 types: 1. Neonatal obstructive type 41 cases. 2. Free perforation with: Free pneumoperitoneum 15 cases. Localized pneumoperitoneum 23 cases. 3. No signs or symptoms, with potential intestinal obstruction 23 cases. The series shows a low incidence of atresia. The authors suggest necrotizing enterocolitis as a cause because of the high incidence of stenosis. Three prenatally diagnosed cases are discussed. All had hydramnios and fetal abdominal calcifications. Two of these were confirmed after birth. The mortality is high (42.6%). Abdominal x-ray in all cases with polyhydramnios may lead to a positive diagnosis of MP.
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14/14. pneumoperitoneum in infants without gastrointestinal perforation.

    pneumoperitoneum signals gastrointestinal perforation and, as a rule, requires prompt laparotomy. However, we have recently encountered infants with severe respiratory distress who developed pneumoperitoneum without any gastrointestinal leak. These 10 patients were managed without operations. Three patients survived the respiratory distress and subsequently manifested no gastrointestinal disturbances. Five patients who died of pulmonary disease after conservative management of pneumoperitoneum had autopsies that revealed no gastrointestinal disease. We found no clinical or radiographic signs of peritonitis in these patients. paracentesis and gastrointestinal x-rays revealed no gastrointestinal perforation. These critically ill newborns were thereby spared an unnecessary laparotomy. This experience confirms previous reports in the literature that, by clinical and radiographic correlations, "medical" pneumoperitoneum can often by distinguished from "surgical" pneumoperitoneum in critically ill infants with respiratory distress who may not easily tolerate an unnecessary laparotomy.
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