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Case Reports
. 2016 Nov;98(8):e197-e199.
doi: 10.1308/rcsann.2016.0240. Epub 2016 Sep 22.

Tension pneumoperitoneum: a very rare complication of acute gangrenous appendicitis

P Das  1 , R Mukherjee  1 , D Pathak  1 , A Gangopadhyay  1 , S Halder  1 , S K Singh  1
Affiliations
Case Reports

Tension pneumoperitoneum: a very rare complication of acute gangrenous appendicitis

P Das et al. Ann R Coll Surg Engl. 2016 Nov.

Abstract

Tension pneumoperitoneum is a very rare consequence of acute gangrenous appendicitis. We report a case of a 32-year-old woman who presented with abdominal pain, progressively increasing abdominal distension, profound hemodynamic instability and ventilatory compromise. The diagnosis of tension pneumoperitoneum was confirmed by computed tomography, which showed compression of the intra-abdominal viscera and liver (saddlebag sign) by a large volume of intraperitoneal free air. Urgent needle decompression was done as an emergency measure. Exploratory laparotomy, planned due to persistent peritonitis, revealed gangrenous appendicitis with perforation near its base. Appendicectomy with excision of gangrenous portion of caecum was performed. The purpose of the reporting this case is to highlight that the tension pneumoperitoneum can be, very rarely, associated with gangrenous appendicitis and timely diagnosis is very important for the emergency management of this deadly condition.

Keywords: Appendicitis; Gangrene; Pneumoperitoneum; Tomography.

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Figures

Figure 1
Figure 1
Coronal computed tomography shows a large volume of intraperitoneal free air has displaced the abdominal viscera
Figure 2
Figure 2
Contrast enhanced axial computed tomography showing evidence of tension pneumoperitoneum with compression of the intra-abdominal viscera and displacement of the liver (saddlebag sign)
See this image and copyright information in PMC

References

    1. Chan SY, Kirsch CM, Jensen WA et al. . Tension pneumoperitoneum. West J Med 1996; : 61–64. - PMC - PubMed
    1. Bunni J, Bryson P, Higgs S. Abdominal compartment syndrome caused by tension pneumoperitoneum in a scuba diver. Ann R Coll Surg Engl 2012; (8): e237–e239. - PMC - PubMed
    1. Miller D. Tension pneumoperitoneum caused by obstipation. West J Emerg Med 2015; (5): 777–780. - PMC - PubMed
    1. Marova K, Chochola M, Golan L et al. . [Liver abscesses with portal and mesenteric vein thrombosis in combination with late onset of appendicitis]. In Czech. Cas Lek Cesk 2005; (7): 489–493. - PubMed
    1. Bakti N, Hussain A, El-Hasani S. A rare complication of acute appendicitis: superior mesenteric vein thrombosis. Int Surg Case Rep 2011; (8): 250–252. - PMC - PubMed

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