A rare case of tension pneumoperitoneum secondary to gastric perforation associated with severe aortic compression

Abstract

A 36-year-old male was critically unwell with acute central abdominal pain and distension. CT demonstrated severe pneumoperitoneum leading to compression and total occlusion of the inferior vena cava and occlusion of the aorta. At laparotomy, a perforated posterior gastric ulcer was found with four quadrant contamination. A damage control procedure was performed and a re-look laparotomy was carried out 2 days later where bowel ischaemia was found. Despite being supported on the intensive care unit, unfortunately the patient died. Tension pneumoperitoneum leading to occlusion of the aorta is very rare and the severity of this condition should be recognised; it has never been survived in the reported literature. Rapid assessment and investigation is essential to ensure the timely treatment of this disease.

Figure 1.

(a) Axial slice of an arterial phase CT scan at the level of the L4 superior endplate with a white arrow showing occlusion of the abdominal aorta (b). Sagittal slice of an arterial phase CT scan demonstrating minimal opacification of the superior mesenteric artery (white arrow) (c). Axial slice of an arterial phase CT, with white arrows demonstrating bilaterally collapsed common iliac arteries (d). Axial slice of an arterial phase CT, with white arrows showing common femoral arteries of normal calibre but with almost no contrast contained within them

Figure 2.

Sagittal slice of an arterial phase CT scan, demonstrating return to normal opacification of the abdominal aorta (white arrows) and the superior mesenteric artery (yellow arrow).