In the United States, about 5,200 people per year die from peritonitis induced by intra-abdominal surgery in the outpatient setting. In 10% or more of these cases the death of the person is due to complications or multiple organ failure. As reported by surgeons, the incidence of the pneumoperitoneum requiring surgery in laparoscopic situations is lower when done by a specialist.
A pneumoperitoneum is an abnormal accumulation of air and fluid in any part of the abdomen. Pneumoperitoneum is associated with penetrating trauma and rupture of the bowel which is frequently seen in blunt abdomen trauma. Pneumomediastinum is accumulation of air and fluid in the mediastinum. These two pneumothoracic lesions are quite similar and a diagnosis of pneumoperitoneum is difficult to differentiate accurately from pneumomediastinum. It is associated with the rupture of organs (including liver, kidney, bowel), penetrating injury and emphysema.
The incidence of pneumoperitoneum, regardless of cause, is not uncommon. Most cases are observed as subacute pneumoperitoneum. Rarely operative intervention may be necessary; however, most cases do not require any treatment.
Pneumoretroperitoneum may present with a sudden onset of intense lower back pain, nausea, vomiting, and a rapidly raised erythrocyte sedimentation rate. Pneumoretroperitoneum is the least recognized yet most common cause of laparotomies in the first 2 hours after a pelvic surgical procedure and causes significant morbidity and mortality. Pneumoperitoneum usually does not affect the course of the patient other than by complicating the procedure and increasing morbidity and mortality.
Results from a recent paper in a large academic referral center shows that pneumoperitoneum must be evaluated and treated before it evolves into severe complications such as empyema or acute cholecystitis or even infection. Appropriate and prompt use of antimicrobials and surgical technique can prevent severe complication to allow for rapid recovery.
Most pneumoperitoneum from bowel perforation is not caused by bowel disease but by a pathogenic condition of the peritoneal cavity. Other causes include intraabdominal surgery such as gynecological procedures and diverticulitis.
Compared to HFCO2 the warm and humidified CO2 pneumoperitoneum does not significantly improve perioperative pain scores, ventilation times, ventilation costs, or length of stay. However, the warm and humidified CO2 pneumoperitoneum results in a slower return of to normal bowel function and a decrease in the use of narcotic.
Treating PSCI using Warm and Humidified co2 Pneumoperitoneum in combination with other treatments is not usually employed but it is an important and well-known alternative to keep the patients comfortable.
During laparoscopic surgery in an atmosphere with a high humidity and warm and humidified CO2 pneumoperitoneum, the effects of aqueous humor and the intraperitoneal gas environment on intraoperative blood clot formation are less marked and postoperative drainage of intraabdominal fluid is better compared to a conventional, ambient air atmosphere laparoscopy. Results from a recent clinical trial, in the authors' opinion, show that the effects of a humidified CO2 pneumoperitoneum should be thoroughly evaluated prior to its application in routine operations.
There are different primary causes of pneumoperitoneum, with abdominal pathology and surgery in the emergency setting associated with the majority of these cases. Pneumoperitoneum in the outpatient clinic most often occurs as a complication of other gastrointestinal surgery. The finding of pneumoperitoneum or peritonitis on CT scan in the emergency department should prompt the clinician to undertake an exploratory laparotomy. Primary surgical intervention is therefore required for the treatment of the most severe complication of bowel injury. The majority of patients can be managed conservatively without operative intervention with or without antibiotics.
The prevalence of intracranial and pneumothoracic pathology increases with increasing pneumoperitoneum (PP) duration. Further studies might be useful to identify clinical and genetic risk factors for intracranial or penetrating pneumothoraces.