|previous article in this issue||next article in this issue|
Document Details :
Title: Pneumoperitoneum zonder peritonitis
Author(s): FITZPATRICK C, DE MEY J, MOERMAN L, SERMIJN E, LACOR P
Journal: Tijdschrift voor Geneeskunde
Volume: 64 Issue: 24 Date: 2008
Pneumoperitoneum without peritonitis
A 83-year-old woman with scleroderma suffering from Raynaud’s phenomenon, painful joints and calcinosis is presented. In a work-up to differentiate between a localized versus a systemic scleroderma, radiographs revealed a massive pneumoperitoneum without pneumothorax. Clinical examination of the abdomen displayed no signs of tenderness or peritonitis. The origin of the free air remained unclear.
Pneumoperitoneum is most commonly caused by the perforation of a hollow viscus, in which case an emergency laparotomy is indicated. Spontaneous or benign pneumoperitoneum without peritonitis occurs rarely and poses a dilemma to the surgeon facing this problem. A literature search of the causes of pneumoperitoneum without peritonitis is presented. In the presence of pneumoperitoneum without peritonitis and when the clinical history does not suggest perforation of a viscus, a conservative management is amenable. The etiology of the pneumoperitoneum in our patient remained unclear, but it has been described in the literature as a rare complication of systemic sclerosis. Our patient remained clinically stable under attentive observation.