Airway management: induced tension pneumoperitoneum

Abstract

Pneumoperitoneum is not always associated with hollow viscus perforation. Such condition is called non-surgical or spontaneous pneumoperitoneum. Intrathoracic causes remain the most frequently reported mechanism inducing this potentially life threatening complication. This clinical condition is associated with therapeutic dilemma. We report a case of a massive isolated pneumoperitoneum causing acute abdominal hypertension syndrome, in a 75 year female, which occurred after difficult airway management and mechanical ventilation. Emergent laparotomy yielded to full recovery. The recognition of such cases for whom surgical management can be avoided is primordial to avoid unnecessary laparotomy and its associated morbidity particularly in the critically ill.

Keywords: Non-surgical pneumoperitoneum; acute abdominal compartment syndrome; barotraumas.

Figure 1

Chest X-ray at ICU admission after airway management and mechanical ventilation. It showed bilateral air collections in subphrenic areas (see arrows)

Figure 2

Thoraco-abdominal computed tomography scan performed one hour after the occurrence of the abdominal distension. It revealed a massive pneumoperitoneum, without intraperitoneal effusion, pneumothorax or pneumomediastinum

Figure 3

Chest X-ray at day 1 of surgical intervention. It showed significant regression of pneumoperitoneum (see arrows)