Pneumoperitoneum

As a pneumoperitoneum ( Greek pneuma πνεύμα = air) is called a filled with air or gas peritoneal cavity ( abdominal cavity).

Causes

The main reason for a pneumoperitoneum are perforations ( injuries) of the gastro- intestinal tract, such as a perforated ulcer. In principle, any part of the digestive tract by means of an ulcer, a trauma or a tumor perforate. Only rarely a perforated appendix vermiformis within the framework of appendicitis leads to a pneumoperitoneum. The introduction of air through the female genital tract is also seen as a cause of Spontanpneumoperitoneums.

For laparoscopic procedures usually a pneumoperitoneum is created artificially. Using a Veres needle or a trocar is this carbon dioxide is introduced into the abdominal cavity. This is thus actually a Capnoperitoneum, but is usually also referred to as pneumoperitoneum. A " gasless " laparoscopy, so-called lift- laparoscopy, has so far not enforced. In the past, a pneumoperitoneum was also artificially induced ( Pneumoperitoneografie ) to achieve a contrast enhancement in diagnostic radiology of the abdomen, but this method is now obsolete.

After all surgical procedures with opening the abdomen can be a few days to demonstrate air in the abdominal cavity, but this is normal and has no clinical significance.

Diagnostics

Detection can be free gas in the abdominal cavity through an x-ray or a CT scan, in which even small amounts are detectable. Even with ultrasound imaging to air volumes can be detected in the abdomen.

If in addition to the open air and free fluid is present in the abdomen, it comes to mirror formation (arrow).

Pneumoperitoneum at an X-ray at a located on the left side of the patient. The free "air" in the abdominal cavity (green arrows) accumulates above the liver ( red arrows on border of the liver ). When free fluid in the abdominal cavity, an air - fluid level forms ( blue arrows).

Therapy

In the cases of morbid pneumoperitoneum treatment of which depends on the cause, with closed injuries and tumors are removed.

A pneumoperitoneum can be even used as a treatment measure. Historically, this has been the case in the treatment of intestinal tuberculosis. As a pre-treatment before operation of large hernias pneumoperitoneum is used to Moreno to slide it out from the abdominal organs hernia sac in some cases.