title: [Abdominal compartment syndrome by tension pneumoperitoneum secondary to barotrauma. Presentation case].
abstract: BACKGROUND
  Pneumoperitoneum is defined as the existence of extraluminal air in the abdominal cavity. In 80-90% of cases is due to perforation of a hollow organ. However, in 10-15% of cases, it is nonsurgical pneumoperitoneum.
  
  
  OBJECTIVE
  The case of a patient undergoing mechanical ventilation, developing abdominal compartment syndrome tension pneumoperitoneum is reported.
  
  
  METHODS
  Female, 75 years old asking for advise due to flu of long term duration. Given her respiratory instability, admission to the Intensive Care Unit is decided. It is then intubated and mechanically ventilated. Chest x-ray revealed a large pneumoperitoneum but no pneumothorax neither mediastinum; and due to the suspicion of viscera perforation with clinical instability secondary to intra-abdominal hypertension box, emergency surgery was decided.
  
  
  CONCLUSIONS
  When discarded medical history as a cause of pneumoperitoneum, it is considered that ventilation is the most common cause. Benign idiopathic or nonsurgical pneumoperitoneum, can be be treated conservatively if the patient agrees. But if intraabdominal hypertension prevails, it can result in severe respiratory and hemodynamic deterioration, sometimes requiring abdominal decompression to immediately get lower abdominal pressure and thus improve hemodynamic function.
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España. Electronic address: esther_garcia_santos@hotmail.com.
authors.forename: Esther
authors.initials: E
authors.lastname: García-Santos
authors.affiliation: Servicio de Urología, Hospital San Pedro de Alcántara, Cáceres, España.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Puerto-Puerto
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
authors.forename: Susana
authors.initials: S
authors.lastname: Sánchez-García
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Ruescas-García
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
authors.forename: Ana
authors.initials: A
authors.lastname: Alberca-Páramo
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
authors.forename: Jesús
authors.initials: J
authors.lastname: Martín-Fernández
mesh_terms: D000368:Aged; D001469:Barotrauma / Q000150:complications* / Q000503:physiopathology; D019299:Decompression, Surgical; D004630:Emergencies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007251:Influenza, Human / Q000150:complications; D007385:Intermittent Positive-Pressure Ventilation; D059325:Intra-Abdominal Hypertension / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007813:Laparotomy; D011027:Pneumoperitoneum / Q000209:etiology* / Q000503:physiopathology; D011650:Pulmonary Alveoli / Q000293:injuries*; D012121:Respiration, Artificial / Q000009:adverse effects*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy
keywords: Abdominal pressure; Barotrauma; Mechanical ventilation; Neumoperitoneo; Pneumoperitoneum; Presión abdominal; Ventilación mecánica