title: Tension pneumoperitoneum: a very rare complication of acute gangrenous appendicitis.
abstract: Tension pneumoperitoneum is a very rare consequence of acute gangrenous appendicitis. We report a case of a 32-year-old woman who presented with abdominal pain, progressively increasing abdominal distension, profound hemodynamic instability and ventilatory compromise. The diagnosis of tension pneumoperitoneum was confirmed by computed tomography, which showed compression of the intra-abdominal viscera and liver (saddlebag sign) by a large volume of intraperitoneal free air. Urgent needle decompression was done as an emergency measure. Exploratory laparotomy, planned due to persistent peritonitis, revealed gangrenous appendicitis with perforation near its base. Appendicectomy with excision of gangrenous portion of caecum was performed. The purpose of the reporting this case is to highlight that the tension pneumoperitoneum can be, very rarely, associated with gangrenous appendicitis and timely diagnosis is very important for the emergency management of this deadly condition.
authors.affiliation: RG Kar Medical College , Kolkata, West Bengal , India.
authors.forename: P
authors.initials: P
authors.lastname: Das
authors.affiliation: RG Kar Medical College , Kolkata, West Bengal , India.
authors.forename: R
authors.initials: R
authors.lastname: Mukherjee
authors.affiliation: RG Kar Medical College , Kolkata, West Bengal , India.
authors.forename: D
authors.initials: D
authors.lastname: Pathak
authors.affiliation: RG Kar Medical College , Kolkata, West Bengal , India.
authors.forename: A
authors.initials: A
authors.lastname: Gangopadhyay
authors.affiliation: RG Kar Medical College , Kolkata, West Bengal , India.
authors.forename: S
authors.initials: S
authors.lastname: Halder
authors.affiliation: RG Kar Medical College , Kolkata, West Bengal , India.
authors.forename: S K
authors.initials: SK
authors.lastname: Singh
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000208:Acute Disease; D000328:Adult; D001062:Appendectomy; D001064:Appendicitis / Q000150:complications* / Q000601:surgery; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D005734:Gangrene / Q000150:complications*; D006801:Humans; D059325:Intra-Abdominal Hypertension / Q000209:etiology / Q000601:surgery; D011027:Pneumoperitoneum / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D014057:Tomography, X-Ray Computed
keywords: Appendicitis; Gangrene; Pneumoperitoneum; Tomography