Korean J Gastroenterol.  2009 Dec;54(6):395-398. 10.4166/kjg.2009.54.6.395.

A Case of Spontaneous Pneumoperitoneum Associated with Idiopathic Intestinal Pseudoobstruction

• Kim HW
• Chon NR
• Kim YS
• Kim JH
• Park H

• KMID: 1775940
• DOI: http://doi.org/10.4166/kjg.2009.54.6.395

Abstract

Pneumoperitoneum, free intra-abdominal air, usually results from the perforation of a hollow viscous. In approximately 10% of cases, however, pneumoperitoneum is not caused by gastrointestinal perforation. These cases of "spontaneous pneumoperitoneum" generally follow more benign course and may not require surgical intervention. Examples include cardiopulmonary resuscitation (CPR), malrotation, mechanical ventilator support, gynecologic manipulation, blunt abdominal trauma, and chronic intestinal pseudoobstruction in infancy (Sieber syndrome). But, it is extremely rare of spontaneous pneumoperitoneum secondary to idiopathic intestinal pseudoobstuction in adult. We herein report a patient with chronic idiopathic intestinal pseudoobstuction who developed a pneumoperitoneum.

Keyword

Spontaneous pneumoperitoneum; Intestinal pseudoobstuction

MeSH Terms

Adult
Chronic Disease
Humans
Intestinal Pseudo-Obstruction/complications/*diagnosis/surgery
Intestine, Small/pathology
Male
Pneumoperitoneum/*diagnosis/etiology/radiography
Tomography, X-Ray Computed

Figure

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  Fig. 1. Initial (2008-02-04) chest x-ray (A) and abdomen x-ray (upright) (B) showed massive free air in abdomen.

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  Fig. 2. Abdomen CT showed moderate amount of ascites (a) and massive free air in abdomen (b). Distension of large and small intestine was seen (c). Segmental intramural gases in the small bowel loops was seen (d).

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  Fig. 3. Small intestine. Vacuolar change at inner circular muscle layer (A) and fibrosis at outer longitudinal muscle layer (B), suggestive of visceral myopathy (H&E, ×400).

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  Fig. 4. Follow up (2008-02-11) abdomen x-ray after discharge showed resolved state of pneumoperitoneum but still remained ileus.

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