Tension pneumoperitoneum associated with a pleural-peritoneal shunt.
The differential diagnosis of pneumoperitoneum is broad. We report a case of tension pneumoperitoneum in a patient on mechanical ventilation with initially unrecognized pneumothorax who had an indwelling pleural-peritoneal shunt. The patient developed ventilatory and hemodynamic collapse as air was diverted from the pleural space into the peritoneal cavity. Subsequent abdominal exploration revealed the source of the intra-abdominal air. Placement of a chest thoracostomy tube and removal of the pleural-peritoneal catheter resulted in significant clinical improvement. We suggest that it is important to recognize that pleural-peritoneal catheters may cause tension pneumoperitoneum without obvious concurrent pneumothorax.
Lipson
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DA
Department of Medicine, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
Tino
G
G
Vaughn
D
D
D000328:Adult; D003937:Diagnosis, Differential; D004322:Drainage / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D008297:Male; D016066:Pleural Effusion, Malignant / Q000628:therapy*; D011027:Pneumoperitoneum / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D011030:Pneumothorax / Q000175:diagnosis; D019736:Prostheses and Implants / Q000009:adverse effects*; D012121:Respiration, Artificial / Q000009:adverse effects; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy