Year : 2017  |  Volume : 10  |  Issue : 2  |  Page : 221--222

Spontaneous pneumoperitoneum: A rare entity

Himanshu Pratap, Neeraj Awasthy, KS Dagar 
 Department of Pediatric Cardiology, Max Super Speciality Hospital, New Delhi, India

Correspondence Address:
Neeraj Awasthy
Department of Pediatric Cardiology, Max Super Speciality Hospital, New Delhi

How to cite this article:
Pratap H, Awasthy N, Dagar K S. Spontaneous pneumoperitoneum: A rare entity.Ann Pediatr Card 2017;10:221-222

How to cite this URL:
Pratap H, Awasthy N, Dagar K S. Spontaneous pneumoperitoneum: A rare entity. Ann Pediatr Card [serial online] 2017 [cited 2021 May 16 ];10:221-222
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Pneumoperitoneum following cardiac surgery is a known entity, given the close anatomic relationship of the pericardium, diaphragm, and peritoneal cavity and is generally incidental and inconsequential. Presumed modes of air entry into the abdomen include the peritoneal tear during sternotomy or chest tube insertion, retroperitoneal, or mediastinal dissection of air in the presence of extraalveolar air or entrapped air while placing a peritoneal dialysis (PD) catheter.[1]

Here, we report an unusual occurrence of a massive pneumoperitoneum in a convalescing patient many days after cardiac surgery, where chest tubes were already removed, a PD catheter was never placed, and chest X-ray was devoid of any free air.

A 2-month-old male child underwent surgery for obstructed total anomalous pulmonary venous connection and was recovering along expected course. Adequacy of repair was assessed to be satisfactory on intraoperative epicardial echocardiography; our institutional protocol restricts the use of intraoperative transesophageal echocardiography to patients weighing more than 10 kg. His chest tubes were removed on 2nd postoperative day (POD). Subsequent chest X-ray was unremarkable for any free air. On 5th POD, he developed gradually increasing abdominal distension. The child was stable hemodynamically. As his distension continued to increase despite conservative treatment, X-ray abdomen was obtained revealing massive pneumoperitoneum [Figure 1] and [Figure 2]. The child remained warm and well perfused with good urine output and without any acidosis or rise in lactate. In view of overall clinical stability, a bedside peritoneal drain was inserted that released significant free air. A peritoneal lavage was reassuring for clear return.{Figure 1}{Figure 2}

Subsequent course was uneventful. The child was extubated on 7th POD; peritoneal drain was removed on 9th POD, and he was discharged on 14th POD.

The occurrence of complication is unusual for the delayed onset and lack of an obvious causal factor; one may speculate about a one-way valve mechanism at the incision or chest tube insertion site or a rapidly healing bowel leak. The importance of simple bedside management, given the absence of signs of bowel perforation, is worth a consideration.

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1Glanz S, Ravin CE, Deren MM. Benign pneumoperitoneum following median sternotomy incision. AJR Am J Roentgenol 1978;131:267-9.