title: Benign spontaneous pneumoperitoneum in systemic sclerosis.
abstract: The gastrointestinal tract is commonly involved in patients with systemic sclerosis (SSc) (Am J Gastroenterol. 1972;58:30-44). Intestinal manifestations of SSc include impaired motility, malabsorption, bacterial overgrowth, jejunal and wide-mouthed colonic diverticuli, localized dilatation, pseudo-obstruction, and, less commonly, pneumatosis cystoides intestinalis (PCI) (Rheumatology. 2009;48:iii36-iii39; J Clin Gastroenterol. 2008;42:5-12). Benign spontaneous pneumoperitoneum is a rare complication of SSc and is often associated with PCI (Mo Med. 1967;64:117-118). We report a case of spontaneous pneumoperitoneum without evidence of peritoneal irritation in a malnourished patient with long-standing SSc. Computed tomography scan of the abdomen and pelvis on admission revealed pneumoperitoneum with PCI without visceral perforation. Subsequent imaging revealed the persistence of the pneumoperitoneum with resolution of the PCI. It is important for the clinician to recognize benign spontaneous pneumoperitoneum as a possible complication in patients with SSc and to be able to differentiate this from a ruptured viscus with peritonitis based on clinical presentation. The management of benign spontaneous pneumoperitoneum is supportive, thereby avoiding unnecessary surgery.
authors.affiliation: Division of Rheumatology, University of Connecticut Health Center, Farmington, CT, USA. johnvischio@yahoo.com
authors.forename: John
authors.initials: J
authors.lastname: Vischio
authors.forename: Zinaida
authors.initials: Z
authors.lastname: Matlyuk-Urman
authors.forename: Santhanam
authors.initials: S
authors.lastname: Lakshminarayanan
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D010100:Oxygen / Q000627:therapeutic use; D010538:Peritonitis / Q000000981:diagnostic imaging; D011006:Pneumatosis Cystoides Intestinalis / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000628:therapy; D011027:Pneumoperitoneum / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000628:therapy; D012595:Scleroderma, Systemic / Q000150:complications*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D010100:Oxygen