Pneumoperitoneum usually indicates rupture of a hollow viscus and considered a surgical emergency. But air may also enter the peritoneum from the lung or the genital organs in female without visceral perforation. While scuba diving, the rapid ascent is usually controlled by placing in a decompression chamber and the excess gas volume is exhaled. Failure to allow this excess gas to escape will result in overdistension of air passage, which may rupture resulting in pulmonary interstitial emphysema or, if air enters the circulation, air embolus can occur. Pneumo-peritoneum is a rare complication of diving accidents. While the majority of cases are not related to an intraabdominal catastrophy, more than 20% have been the result of gastric rupture. We report a 42-yr-old male patient with massive pneumoperitoneum after scuba diving, who presented himself with dyspnea and abdominal distension. Knowledge of this rare condition and its benign course may allow the emergency physician and surgeon to order appropriate studies to help avoid unnecessary surgical treatment. It is important to determine promptly whether the air emanated from a ruptured viscus or was introduced from an extraperitoneal source. Free air in the abdomen does not always indicate a ruptured intra-abdominal viscus.
Adult ; Diving/adverse effects* ; Female ; Human ; Male ; Pneumoperitoneum/diagnosis* ; Pneumoperitoneum/etiology* ; Radiography, Abdominal ; Radiography, Thoracic

Pneumatosis cystoides intestinalis is a rare condition which is characterized by multiple gas-filled cysts of varying sizes in the wall of the gastrointestinal tract. In 85% of the cases, it is associated with gastrointestinal, pulmonary, and connective tissue diseases or with other conditions. In about 15% of the cases, the etiology remains obscure. In most cases, the prognosis is poor, so early diagnosis and treatment are required. We report two cases of primary pneumatosis cystoides intestinalis with portal venous gas which were associated with alcoholism and diabetes mellites and which were complicated by pneumoperitoneum and panperitonitis.
Alcoholism ; Connective Tissue Diseases ; Early Diagnosis ; Gastrointestinal Tract ; Pneumatosis Cystoides Intestinalis* ; Pneumoperitoneum ; Portal Vein ; Prognosis

Acute appendicitis is very rare in premature neonates. Preoperative diagnosis of this condition is difficult, and then it leads to high morbidity and mortality. We report 9-day-old premature male with ruptured acute appendicitis presented with pneumoperitoneum on plain films of the abdomen. Awareness of this rare condition and possible differential diagnosis in this age group is also discussed.
Abdomen ; Appendicitis ; Diagnosis, Differential ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Male ; Pneumoperitoneum

Emphysematous pyelonephritis (EPN) is a life-threatening suppurative infection of the renal parenchyma, with formation of gas within the collecting system, renal parenchyma, or perirenal tissues. Since Kelly and MacCullum reported the first case of pneumaturia from a gas-forming renal infection, several terms have been used to describe the condition, such as renal emphysema, pneumonephritis, and emphysematous pyelonephritis. We describe a case of emphysematous pyelonephritis, which presented as an acute abdomen with pneumoperitoneum and pneumomediastinum in a diabetic patient. A subsequent exploratory laparotomy did not identify the site of visceral perforation or the source of infection, and an ensuing nephrectomy with intensive antibiotic therapy was lifesaving. Occasionally, retroperitoneal infection can contaminate the peritoneal cavity and produce gas to create pneumoperitoneum, and retroperitoneal air can migrate to the mediastinum to create a pneumomediastinum. Therefore, we recommend that a differential diagnosis of a pneumoperitoneum or a pneumomediastinum should also include retroperitoneal infection, such as emphysematous pyelonephritis.
Abdomen, Acute ; Diagnosis, Differential ; Emphysema ; Humans ; Laparotomy ; Mediastinal Emphysema* ; Mediastinum ; Nephrectomy ; Peritoneal Cavity ; Pneumoperitoneum* ; Pyelonephritis*

The initial radiologic evaluation of a patient with acute abdominal symptoms begins with plain abdominal radiographs. Plain abdominal radiographs are helpful for the diagnosis of intestinal obstruction and pneumoperitoneum. However, cross-sectional imaging modalities, such as ultrasonography or computed tomography, are necessary for specific diagnosis of acute abdomen. Ultrasonography is a non-invasive and comfortable tool for patients visiting emergency room. This article describes the ultrasonographic findings of most common diseases presenting with acute abdominal symptoms.
Abdomen, Acute* ; Diagnosis ; Emergency Service, Hospital ; Humans ; Intestinal Obstruction ; Pneumoperitoneum ; Ultrasonography*

The pneumoretroperitoneum has many etiologies. These range from the clinically insignificant to the potentially fatal, if not recognized promptly. Spontaneous pneumoretroperitoneum can develope from ulcerative colitis, colonic diverti-culitis, or duodenal ulcer perforation. It can be associated with pneumothorax, pneumomediastinum, respiratoy tract rupture, etc. An isolated pneumoretroperitoneum are a more obscure symptom than a pneumoperitoneum. Mostly, the diagnosis of retroperitoneal air depends of radiologic methods, such as simple X-ray, ultrasound (US), or computerized tomography (CT) measurements. In this case, we diagnosed a pneumoretroperitoneum from CT and found that it caused the perforation of the colon spontaneously, without any underlying diseases, due to chronic constipation without underlying diseases
Colitis, Ulcerative ; Colon ; Constipation ; Diagnosis ; Duodenal Ulcer ; Mediastinal Emphysema ; Pneumoperitoneum ; Pneumothorax ; Retropneumoperitoneum* ; Rupture ; Ultrasonography

Flexible fiberoptic colonoscopy is extensively used for the diagnosis and management of colorectal disease. Many possible complications can occur. The most common and most serious complications are hemorrhage, perforation and respiratory problems. Colonic perforation usually results in a fatal and emergent condition. However, management of iatrogenic colonic perforation has been controversial. The choice between the medical versus the surgical approach has been dependent on the mechanism of the perforation, bowel preparation, location, size of the defect and severity of symptoms. We report here a case where colonic perforation emerged during endoscopic submucosal resection of a rectal tumor. The rectal perforation was accompanied with pneumoperitoneum, subcutaneous emphysema, pneumoretroperitoneum and pneumomediastinum. As the bowel preparation was excellent, intravenous antibiotics and total parenteral nutirition were administered. The patient was treated successfully without any complications.
Anti-Bacterial Agents ; Colon ; Colonoscopy ; Diagnosis ; Hemorrhage ; Humans ; Mediastinal Emphysema* ; Pneumoperitoneum* ; Rectal Neoplasms ; Retropneumoperitoneum* ; Subcutaneous Emphysema*

Flexible fiberoptic colonoscopy is extensively used for the diagnosis and management of colorectal disease. Many possible complications can occur. The most common and most serious complications are hemorrhage, perforation and respiratory problems. Colonic perforation usually results in a fatal and emergent condition. However, management of iatrogenic colonic perforation has been controversial. The choice between the medical versus the surgical approach has been dependent on the mechanism of the perforation, bowel preparation, location, size of the defect and severity of symptoms. We report here a case where colonic perforation emerged during endoscopic submucosal resection of a rectal tumor. The rectal perforation was accompanied with pneumoperitoneum, subcutaneous emphysema, pneumoretroperitoneum and pneumomediastinum. As the bowel preparation was excellent, intravenous antibiotics and total parenteral nutirition were administered. The patient was treated successfully without any complications.
Anti-Bacterial Agents ; Colon ; Colonoscopy ; Diagnosis ; Hemorrhage ; Humans ; Mediastinal Emphysema* ; Pneumoperitoneum* ; Rectal Neoplasms ; Retropneumoperitoneum* ; Subcutaneous Emphysema*

This paper presents a case report of tension pneumoperitoneum that occurred in a 4-month-old girl with intussusception during pneumatic reduction. Tension pneumoperitoneum is a rare but life threatening complication in air pressure enema that is commonly used to turn the intussuscepted bowel to its original position. The incidence of a simple pneumoperitoneum due to a bowel perforation associated with attempted pneumatic reduction for intussusception is as high as 4%. The simple pneumoperitoneum changed rapidly to tension pneumoperitoneum and immediate needle decompression was life-saving in this case. Similar to a tension pneumothorax, the diagnosis is clinical and management should not be delayed awaiting other confirmatory tests. The emergency physician must recognize this rare complication of pneumatic reduction and promptly treat the ensuing tension pneumoperitoneum after bowel perforation with immediate needle decompression as a part of the initial resuscitation.
Air Pressure ; Decompression ; Diagnosis ; Emergencies ; Enema ; Female ; Humans ; Incidence ; Infant ; Intussusception* ; Needles ; Pneumoperitoneum* ; Pneumothorax ; Resuscitation

Spontaneous gastric perforation of the newborn is a rare, serious and life-threatening problem. This is surgical emergency because of high mortality. Most historical reports have described gastric perforation in the neonate as spontaneous cause. But, recent reviews report the contributing factor including prematurity and mechanical ventilation. Usually clinician identifies the pneumoperitoneum in simple abdomen X-ray. The final diagnostic method is surgical finding and the treatment of gastric perforation is immediate surgical correction. Early diagnosis, hemodynamic monitoring and fluid therapy for hypovolemia improve outcome. Pseudocyst formation after gastric perforation is very rare in newborn. We report a rare case of pseudocyst formation after spontaneous gastric perforation in full term newborn.
Abdomen ; Early Diagnosis ; Emergencies ; Fluid Therapy ; Hemodynamics ; Humans ; Hypovolemia ; Infant, Newborn ; Mortality ; Pneumoperitoneum ; Respiration, Artificial