Alumi Laparoscopic Discussion Board

Difference between Perforation and Pneumoperitoneum
Discussion in 'All Categories' started by Dr Terence Disuza - Aug 22nd, 2016 12:33 pm.
Dr Terence Disuza
Dr Terence Disuza
Dear Sir,

If the bowel is perforated during laparoscopy and second day of surgery x-ray of abdomen is taken how can we differentiate that it is a gas from perforated bowel or it is the remaining pneumoperitoneum of CO2 left inside?
re: Difference between Perforation and Pneumoperitoneum by Dr R K Mishra - Aug 23rd, 2016 2:14 am
Dr R K Mishra
Dr R K Mishra
Dear Dr Disuza

Ppneumoperitoneum is defined as gas trapped within the peritoneal cavity, but outside the lumen of the bowel. Pneumoperitoneum can be due to bowel perforation, or due to insufflation of gas (CO2 during laparoscopy). Both these causes have identical X-ray or CT appearances, but very different clinical significance.

The general condition of the patient and a thorough physical examination are crucial and are often the most important determinants to differentiate between pneumoperitoneum of laparoscopy and pneumoperitoneum of bowel perforation. When signs of sepsis such as fever, tachycardia, tachypnoea and leucocytosis are absent bowel perforation should be considered.

Contrast CT can often reveal underlying etiology; it can show gas in the portal venous system, foreign bodies, bowel wall masses, and other possible clues. The presence of intraperitoneal fluid usually means bowel pathology although it may be confused with the bleeding or irrigation fluid left after surgery.

A large amount of intra-peritoneal gas is typical for pneumoperitoneum of laparoscopy. In cases of viscus perforation, enteric contamination of the peritoneal cavity develops rapidly and omentum wants to seal the perforation, therefore only a small amount of air escapes the hollow organ before the patient is thoroughly examined. In cases of remaining CO2 pneumoperitoneum, no signs of peritonitis or sepsis are present, therefore more air enters the peritoneal cavity. Most of the time CO2 pneumopertitoneum get absorbed within three to four days after surgery and it should not create any increase in pain.

May be this will help us to differentiate the origin of pneumoperitoneum.

With regard
Dr R K Mishra

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