title: Spontaneous pneumoperitoneum. A surgical dilemma.
abstract: Pneumoperitoneum is usually the result of hollow viscus perforation with associated peritonitis. Nonsurgical spontaneous pneumoperitoneum incidental to intrathoracic, intra-abdominal, gynecologic, iatrogenic, and other miscellaneous causes not associated with perforated viscus have been documented in the literature. Seven cases of spontaneous pneumoperitoneum admitted over 3-year period to Grady Memorial Hospital, Atlanta, Georgia are reported. Six patients with pneumoperitoneum underwent exploratory laparotomy when clinical examination suggested an acute abdomen; no intra-abdominal pathology was documented in any of these patients. A seventh patient, on ventilatory support, was managed conservatively after performing a diagnostic peritoneal lavage that was negative. There were no cases of radiographically misdiagnosed pneumoperitoneum. Pneumoperitoneum, preceded by a reasonable incidental cause in a patient with a adequate abdominal examination, may warrant continued observation thus avoiding an unnecessary laparotomy.
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: H M
authors.initials: HM
authors.lastname: van Gelder
authors.forename: K B
authors.initials: KB
authors.lastname: Allen
authors.forename: B
authors.initials: B
authors.lastname: Renz
authors.forename: R
authors.initials: R
authors.lastname: Sherman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D011027:Pneumoperitoneum / Q000209:etiology* / Q000601:surgery