1.Massive Pneumoperitoneum After Scuba Diving.
Seung Tak OH ; Wook KIM ; Hae Myung JEON ; Jeong Soo KIM ; Kee Whan KIM ; Seung Jin YOO ; Eung Kuk KIM
Journal of Korean Medical Science 2003;18(2):281-283
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
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Diving/adverse effects*
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Female
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Human
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Male
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Pneumoperitoneum/diagnosis*
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Pneumoperitoneum/etiology*
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Radiography, Abdominal
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Radiography, Thoracic
2.A Pneumonia Patient with Worsening Respiratory Distress by Chilaiditi Syndrome: A Case Report.
Chang Ho LEE ; Won Young SUNG ; Jang Young LEE ; Sang Won SEO
Journal of the Korean Society of Emergency Medicine 2016;27(2):219-222
Chilaiditi sign refers to the presence of bowel gas under the right diaphragm which is similar in appearance to a pneumoperitoneum on radiography, and is caused by abnormal anatomic positioning of the colon or small bowel between the liver and the diaphragm. When symptoms are present, this condition is known as Chilaiditi syndrome. The most common symptoms are gastrointestinal. It has been less commonly associated with chronic, recurrent respiratory distress. We report acute respiratory distress without gastrointestinal symptoms exacerbated by Chilaiditi syndrome in a pneumonia patient with no history of chronic respiratory disease.
Chilaiditi Syndrome*
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Colon
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Diaphragm
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Hernia, Diaphragmatic
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Humans
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Liver
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Pneumonia*
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Pneumoperitoneum
;
Radiography
3.Neonatal Spontaneous Gastric Perforation Caused by Group B Streptococcus (GBS) Chorioamnionitis.
Korean Journal of Perinatology 2007;18(4):438-442
We describe a case of spontaneous neonatal gastric perforation in a premature infant girl of 27(+1)- week gestational age with respiratory distress syndrome baby. The patient presented within postnatal 36 hours with abdominal distension, respiratory distress, and massive pneumoperitoneum on radiography. Ischemic perforation of the stomach tissues caused by an intrauterine infection from group B streptococcus chorioamnionitis was noted. This is the first report of a spontaneous neonatal gastric perforation caused by group B streptococcus chorioamnionitis in the literature.
Chorioamnionitis*
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Female
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Gestational Age
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Humans
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Infant, Newborn
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Infant, Premature
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Pneumoperitoneum
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Pregnancy
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Radiography
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Stomach
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Streptococcus*
4.Mesocolon Laceration Following Colonoscopy.
Yong jun CHOI ; Jin Seok PARK ; Gyung Eun KIM ; Jee Young HAN ; So Yun NAH ; Byoung Wook BANG
The Korean Journal of Gastroenterology 2014;63(5):313-315
Colonoscopic examination is a safe procedure, however, unexpected complications can sometimes occur. Bleeding and perforation of the colon have been reported as the most common complications. Hemoperitoneum after colonoscopy is an unusual complication, but it may be catastrophic. We report on a 20-year-old man who experienced left low quadrant pain after undergoing colonoscopy. Hemoperitoneum was diagnosed using abdominal CT. A laparoscopic exploration was urgently performed, revealing a lacerated mesocolon of the descending colon. Bleeding of the injured site was controlled without complication. The patient recovered fully without signs of recurrent bleeding. This report implies that if the patient has persistent abdominal pain after undergoing colonoscopy, we should consider hemoperitoneum as one of the causes. To the best of our knowledge, no case of isolated laceration of the mesocolon of the descending colon after colonoscopy has been reported.
Colonoscopy/adverse effects
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Hemorrhage/etiology
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Humans
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Lacerations/*diagnosis/radiography
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Laparoscopy
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Male
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Mesocolon/blood supply
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Pneumoperitoneum/radiography
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Tomography, X-Ray Computed
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Young Adult
5.A Case of Gastric Lymphoepithelioma-like Carcinoma Presenting as Panperitonitis by Perforation of Stomach.
Pyung Gohn GOH ; Eui Sik KIM ; Yun Jeung KIM ; Soo Youn LEE ; Hee Seok MOON ; Seok Hyun KIM ; Byung Seok LEE ; Hyun Yong JEONG
The Korean Journal of Gastroenterology 2011;58(4):208-211
Gastric lymphoepithelioma-like carcinoma is a rare carcinoma among gastric malignant tumor but has a good prognosis. The carcinoma has histologic feature characterized by small nest of cancer cells mixed with lymphoid stroma. We report a case with lymphoepithelioma-like carcinoma of stomach initially presenting as panperitonitis because of spontaneous tumor perforation. A 56-year-old man visited our emergency room because of epigastric pain. A preoperative abdominal CT scan showed a massive pneumoperitoneum in the upper abdomen, and the presence of gastric cancer in the lesser curvature of the stomach. An emergent laparotomy was performed followed by radical subtotal gastrectomy. Pathologic examination revealed that the tumor was a lymphoepithelioma-like gastric carcinoma.
Carcinoma/*diagnosis/pathology/therapy
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Combined Modality Therapy
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Humans
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Lymphoma/radiography/surgery
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Male
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Middle Aged
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Pneumoperitoneum/etiology/radiography/surgery
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Rupture, Spontaneous
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Stomach Neoplasms/*complications/*diagnosis/pathology/therapy
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Stomach Rupture/*complications/radiography/surgery
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Tomography, X-Ray Computed
6.Carbon dioxide pneumothorax occurring during laparoscopy-assisted gastrectomy due to a congenital diaphragmatic defect: a case report.
Hye Jin PARK ; Duk Kyung KIM ; Mi Kyung YANG ; Jeong Eun SEO ; Ji Hye KWON
Korean Journal of Anesthesiology 2016;69(1):88-92
During laparoscopic surgery, carbon dioxide (CO2) pneumothorax can develop due to a congenital defect in the diaphragm. We present a case of a spontaneous massive left-sided pneumothorax that occurred during laparoscopy-assisted gastrectomy, because of an escape of intraperitoneal CO2 gas, under pressure, into the pleural cavity through a congenital defect in the esophageal hiatus of the left diaphragm. This was confirmed on intraoperative chest radiography and laparoscopic inspection. This CO2 pneumothorax caused tolerable hemodynamic and respiratory consequences, and was rapidly reversible after release of the pneumoperitoneum. Thus, a conservative approach was adopted, and the remainder of the surgery was completed, laparoscopically. Due to the high solubility of CO2 gas and the extra-pulmonary mechanism, CO2 pneumothorax with otherwise hemodynamically stable conditions can be managed by conservative modalities, avoiding unnecessary chest tube insertion or conversion to an open procedure.
Carbon Dioxide*
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Carbon*
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Chest Tubes
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Congenital Abnormalities
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Conversion to Open Surgery
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Diaphragm
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Gastrectomy*
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Hemodynamics
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Laparoscopy
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Pleural Cavity
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Pneumoperitoneum
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Pneumothorax*
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Radiography
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Solubility
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Thorax
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United Nations
7.A Case of Spontaneous Pneumoperitoneum Associated with Idiopathic Intestinal Pseudoobstruction.
Hye Won KIM ; Nu Ri CHON ; Young Shin KIM ; Jie Hyun KIM ; Hyojin PARK
The Korean Journal of Gastroenterology 2009;54(6):395-398
Pneumoperitoneum, free intra-abdominal air, usually results from the perforation of a hollow viscous. In approximately 10% of cases, however, pneumoperitoneum is not caused by gastrointestinal perforation. These cases of "spontaneous pneumoperitoneum" generally follow more benign course and may not require surgical intervention. Examples include cardiopulmonary resuscitation (CPR), malrotation, mechanical ventilator support, gynecologic manipulation, blunt abdominal trauma, and chronic intestinal pseudoobstruction in infancy (Sieber syndrome). But, it is extremely rare of spontaneous pneumoperitoneum secondary to idiopathic intestinal pseudoobstuction in adult. We herein report a patient with chronic idiopathic intestinal pseudoobstuction who developed a pneumoperitoneum.
Adult
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Chronic Disease
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Humans
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Intestinal Pseudo-Obstruction/complications/*diagnosis/surgery
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Intestine, Small/pathology
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Male
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Pneumoperitoneum/*diagnosis/etiology/radiography
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Tomography, X-Ray Computed
8.Severe Complication of Percutaneous Dilatational Tracheostomy.
Young Jin CHO ; Ji Hyung LIM ; Yong Joo LEE ; Inn Chul NAM
Journal of the Korean Society of Laryngology Phoniatrics and Logopedics 2016;27(1):54-57
Percutaneous dilatational tracheostomy (PDT) has become an increasingly popular method of establishing an airway for patients in need of chronic ventilator assistance. We report a rare case of a 42-year-old female who developed extensive subcutaneous emphysema, bilateral pneumothoraces, pneumomediastinum, and pneumoperitoneum after percutaneous dilatational tracheostomy. The patient suffered from amyotrophic lateral sclerosis, and underwent PDT after a period of mechanical ventilation. During PDT, tracheostomy tube was inserted into the paratracheal space. Follow-up chest radiography and computed tomography of chest and abdomen revealed extensive subcutaneous emphysema, bilateral pneumothoraces, pneumomediastinum, and pneumoperitoneum. The patient was treated successfully with insertion of the thoracostomy tube and conservative care.
Abdomen
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Adult
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Amyotrophic Lateral Sclerosis
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Female
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Follow-Up Studies
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Humans
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Mediastinal Emphysema
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Methods
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Pneumoperitoneum
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Radiography
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Respiration, Artificial
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Subcutaneous Emphysema
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Thoracostomy
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Thorax
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Tracheostomy*
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Ventilators, Mechanical
9.A Case of Recurrent Pneumatosis Cystoides Intestinalis Associated with Recurrent Pneumoperitoneum.
Ju Yee PARK ; Jae Young YOON ; Sun Yang MIN ; Seung Kwon HONG ; Ju Sang PARK ; Eun Jeong JANG ; Hyun Wook BAIK ; Sang Jong PARK
The Korean Journal of Gastroenterology 2007;50(3):188-192
Pneumatosis cystoides intestinalis is an uncommon condition of unknown etiology, characterized by the presence of multiple gas filled cysts in the gastrointestinal tract. Many different causes of pneumatosis cystoides intestinalis have been proposed, including mechanical, pulmonary, and bacterial causes. Approximately 85% of cases are thought to be secondary to coexisting disorders of the gastrointestinal tract or the respiratory system. The condition has been associated with the therapeutic uses of lactulose, steroids, and various cancer chemotherapeutic regimens. Lactitol is a disaccharide analogue of lactulose which is available as a pure crystalline powder. There are three previous case reports suggestive of lactulose causing pnumatosis intestinalis. We report a case of recurrent pneumatosis cystoides intestinalis associated with benign recurrent pneumoperitoneum developed probably secondary to lactitol therapy.
Adult
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Cathartics/adverse effects/therapeutic use
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Female
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Humans
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Pneumatosis Cystoides Intestinalis/*diagnosis/etiology/radiography
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Pneumoperitoneum/complications/*diagnosis
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Recurrence
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Sugar Alcohols/adverse effects/therapeutic use
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Tomography, X-Ray Computed
10.Pneumatosis intestinalis after adult living donor liver transplantation: report of three cases and collective literature review.
Cheon Soo PARK ; Shin HWANG ; Dong Hwan JUNG ; Gi Won SONG ; Deok Bog MOON ; Chul Soo AHN ; Gil Chun PARK ; Ki Hun KIM ; Tae Yong HA ; Sung Gyu LEE
Korean Journal of Hepato-Biliary-Pancreatic Surgery 2015;19(1):25-29
BACKGROUNDS/AIMS: Pneumatosis intestinalis (PI) is a condition in which multiple gas-filled mural cysts develop in the gastrointestinal tract. Although its exact etiology remains obscure, PI is rarely observed in liver transplant (LT) recipients. METHODS: In 317 cases of adult living donor LT (LDLT) performed during 2011, PI developed in three patients during the 3 year follow-up. RESULTS: Of these three patients, the two who demonstrated PI at 6 weeks and 2 months after LT, respectively, were asymptomatic and showed no signs of secondary complications. Diagnosis was made incidentally using abdominal radiographs and computed tomography (CT) scans. PI was identified in the right ascending colon with concomitant pneumoperitoneum. These two patients received supportive care and maintained a regular diet. Follow-up CT scans demonstrated spontaneous resolution of PI with no complications. The third patient was admitted to the emergency room 30 months after LDLT. His symptoms included poor oral intake and intermittent abdominal pain with no passage of gas. Abdominal radiography and CT scans demonstrated PI in the entire small bowel, with small bowel dilatation, pneumoperitoneum, and pneumoretroperitoneum, but no peritonitis. Physical examination revealed abdominal distension but no tenderness or rebound tenderness. After 1 week of conservative treatment, including bowel rest and antibiotics therapy, PI and pneumoperitoneum resolved spontaneously without complications. CONCLUSIONS: We suggest that adult LDLT recipients who develop asymptomatic or symptomatic PI with no signs of secondary complications can be successfully managed with conservative treatment.
Abdominal Pain
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Adult*
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Anti-Bacterial Agents
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Colon, Ascending
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Diagnosis
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Diet
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Dilatation
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Emergency Service, Hospital
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Follow-Up Studies
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Gastrointestinal Tract
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Humans
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Liver
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Liver Transplantation*
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Living Donors*
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Peritonitis
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Physical Examination
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Pneumoperitoneum
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Radiography, Abdominal
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Retropneumoperitoneum
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Tomography, X-Ray Computed