Pneumoperitoneum is the presence of air or gas in the abdominal (peritoneal) cavity. It is often seen on X-ray, but small amounts are often missed, and CT is …
Pneumoperitoneum is the presence of air or
gas in the abdominal cavity. It is often seen
on X-ray, but small amounts are often missed,
and CT is nowadays regarded as a criterion
standard in the assessment of a pneumoperitoneum.
CT can visualize quantities as small as 5 cm³
of air or gas. The most common cause is a
perforated abdominal viscus, generally a perforated
peptic ulcer, although any part of the bowel
may perforate from a benign ulcer, tumor or
abdominal trauma. A perforated appendix seldom
causes a pneumoperitoneum.
In the mid-twentieth century, an "artificial"
pneumoperitoneum was sometimes intentionally
administered as a treatment for a hiatal hernia.
This was achieved by insufflating the abdomen
with carbon dioxide. The practice is currently
used by surgical teams in order to perform
laparoscopic surgery.
Causes
Perforated duodenal ulcer – The most common
cause of rupture in the abdomen. Especially
of the anterior aspect of the first part of
the duodenum.
Perforated peptic ulcer
Bowel obstruction
Ruptured diverticulum
Penetrating trauma
Ruptured inflammatory bowel disease
Necrotising enterocolitis/Pneumatosis coli
Bowel cancer
Ischemic bowel
Steroids
After laparotomy
After laparoscopy
Breakdown of a surgical anastomosis
Bowel injury after endoscopy
Peritoneal dialysis
Vaginal insufflation
Colonic or peritoneal infection
From chest
Non-invasive PAP can force air down duodenum
as well as down trachea.
Differential diagnosis
Subphrenic abscess, bowel interposed between
diaphragm and liver, and linear atelectasis
at the base of the lungs can simulate free
air under the diaphragm on a chest X-ray.
See also
Football sign
Rigler's sign
References
^ Ali Nawaz Khan. "eMedicine.com: Pneumoperitoneum". 
^ Necrotizing Enterocolitis Bugs, Drugs and
Things That Go Bump in the Night
^ Sexual Activity as Cause for Non-Surgical
Pneumoperitoneum

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