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PubMed1977

Pneumoperitoneum complicating mechanical ventilator therapy.

Subdiaphragmatic air arouses the clinical suspicion of a perforated intra-abdominal viscus. In patients with respiratory failure requiring mechanical ventilation, the retroperitoneal dissection of air from the mediastinum may give rise to radiologic evidence of subdiaphragmatic emphysema. The present report describes four patients with this syndrome. In three of them, a perforated gastric or duodenal ulcer was initially suspected. None of these three patients underwent surgery. Autopsy examinations in two patients revealed extraperitoneal subdiaphragmatic emphysema with secondary rupture into the free peritoneal cavity. The third patient had an uneventful recovery and was discharged from the hospital. In a fourth patient, signs of peritonitis prompted an exploratory laparotomy. No perforation of an intraperitoneal viscus was identified. Upper gastrointestinal contrast roentgenography and peritoneal lavage may help determine the etiology of subdiaphragmatic air in patients undergoing therapy with a mechanical ventilator.

Adolescent↗
PubMed1979

Pneumoperitoneum and pneumoretroperitoneum. Consequences of positive end-expiratory pressure therapy.

Patients receiving positive end-expiratory pressure (PEEP) therapy should be considered at risk for pneumoperitoneum. In the four patients described, chest roentgenographic demonstration of pulmonary interstitial gas and pneumomediastinum, frequently but not always associated with pneumothorax, preceded the dissection of gas into the abdominal cavity. Neither prompt intubation of the pleural space with reexpansion of the lung in the event of pneumothorax nor decrease in the PEEP applied precluded dissection of gas from the mediastinum into the retroperitoneal and peritoneal spaces. This sequence of roentgenographic events should strongly suggest pneumoretroperitoneum and pneumoperitoneum as a sequela to PEEP therapy rather than a ruptured viscus.

Adult↗
PubMed1993

Pathophysiology, recognition and management of pneumoretroperitoneum.

The medical records of 15 patients found to have pneumoretroperitoneum in a 10-year period were reviewed. The cause of retroperitoneal emphysema was infection in six patients, trauma in five and iatrogenic in four. Emphysema was confined to the retroperitoneum in 11 patients, and extended to the mediastinum in four and to the soft tissue of the neck in three. Failure to diagnose pneumoretroperitoneum resulted in delayed intervention in two patients. One patient with pneumoretroperitoneum and pneumoperitoneum secondary to a lung lesion underwent unnecessary laparotomy. Outcome was favourable in these three patients. The presence of air in the retroperitoneum is not dangerous but its early recognition and detection of the source are important as septic conditions may be involved.

Adolescent↗
PubMed2005

Diffuse soft tissue emphysema in anorexia nervosa: a case report.

OBJECTIVE: Anorexia nervosa (AN) is an eating disorder that occurs mainly among young females and its prevalence has increased in recent decades. METHODS: We reported a patient with AN with spontaneous diffuse soft tissue emphysema and bicytopenia, both of which are very rare complications of AN. Our patient, a 20-year-old woman, had lost 41.6% of her previous body weight within 9 months. Her body mass index was 10.8 and amenorrhea had persisted for 5 months. RESULTS: After admission, she was diagnosed with AN-restrictive subtype. She was noted to have crunching sounds in the neck and upper chest wall during hospitalization. A chest X-ray and chest computed tomography scan both revealed diffuse soft tissue emphysema including subcutaneous emphysema, pneumomediastinum, and pneumoretroperitoneum. DISCUSSION: Diffuse soft tissue emphysema improved gradually and completely resolved on the 21st day of hospitalization. This condition seems to be benign and only a short period of hospitalization is required.

Adult↗
PubMed2005

Advanced anorexia nervosa, associated with pneumomediastinum, pneumothorax, and soft-tissue emphysema without esophageal lesion.

OBJECTIVE: We describe the case of a 20-year-old female patient suffering from anorexia nervosa since the age 15 of years. When admitted, she was 168 cm tall with a weight of 35 kg (body mass index [BMI] = 12.4). A week after admission, the patient complained of retrosternal pain, and a few hours later she developed extensive soft-tissue emphysema. METHODS: The X-ray picture of her thorax showed left-hand supraclavicular and infraclavicular emphysema, extensive emphysema in both sides of the soft tissue of the throat, a left-hand apical pneumothorax (4 mm), and a pneumomediastinum. RESULTS: We discuss the extent to which these symptoms are interrelated in the sense of a causal nexus. CONCLUSION: We ruled out any other differential-diagnostic etiopathogenic factors and concluded that the cause of our patient's soft-tissue emphysema, pneumothorax, and pneumomediastinum might well be autodestructive behavior.

Adult↗
PubMed1985

Pulmonary complications following endotracheal intubation for anesthesia in breech extraction.

A 28-year-old, healthy pregnant patient developed bilateral pneumothorax, subcutaneous emphysema, pneumomediastinum, pneumoretroperitoneum and pneumoperitoneum following endotracheal intubation and manual ventilation during general anesthesia for breech extraction. It is likely that positive-pressure ventilation was the cause for this very rare combination of complications. Early recognition and treatment may prevent such a catastrophe.

Adult↗
PubMed1981

Localized intra- and retroperitoneal gas collections following intraoperative use of surgical gelatine sponge.

Following recent intra- or retroperitoneal surgery, four children in whom hemostasis was obtained by means of abundant use of surgical gelatine sponge, displayed unusual bubbly air collections in the region of the operation. Three of them had vague inflammatory symptoms and signs, while in the fourth the gas was discovered incidentally. The connection between the radiological finding and the hemostatic agent is presented. In the typical case manifesting a mild clinical course, knowledge of this association helps to guard against the diagnosis of abscess, and subsequent unnecessary reoperation can be avoided.

Child↗