Topics Discussed: gastroenterology and hepatology; pneumoperitoneum.
Excerpt:"Problem. A pneumoperitoneum (an abnormal collection of air in the peritoneal cavity) is seen on an abdominal radiograph. The air can be secondary to perforation of the gastrointestinal (GI) tract (most common), from the respiratory tract, or secondary to iatrogenic causes (uncommon).
Immediate questions
- Are signs or symptoms of pneumoperitoneum present? These findings can include abdominal distention, respiratory distress, deteriorating blood gas levels, and a decrease in blood pressure.
- Were signs or symptoms of necrotizing enterocolitis (NEC) present before? If so, the pneumoperitoneum is most likely to be associated with GI tract perforation.
- Are any signs of air leak present? If a pneumomediastinum, pulmonary interstitial emphysema, or pneumothorax is present, the peritoneal air collection is more likely to be of respiratory tract origin.
- Is mechanical ventilation being given? High peak inspiratory pressures (PIPs) > a mean of 34 cm H2O can be associated with a pneumoperitoneum.
- Did the infant recently undergo abdominal surgery or an invasive procedure such as paracentesis? Intra-abdominal air is normal in the immediate..."
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