TY - JOUR
T1 - The etiology of pneumoperitoneum in the 21st century
AU - Kumar, Ashwini
AU - Muir, Mark T.
AU - Cohn, Stephen M.
AU - Salhanick, Marc A.
AU - Lankford, Daniel B.
AU - Katabathina, Venkata S.
PY - 2012/9/1
Y1 - 2012/9/1
N2 - Background: We sought to determine the origin of free intraperitoneal air in this era of diminishing prevalence of peptic ulcer disease and imaging studies. In addition, we attempted to stratify the origin of free air by the size of the air collection. Methods: We queried our hospital database for "pneumoperitoneum" from 2005 to 2007 and for proven gastrointestinal perforation from 2000 to 2007. Massive amount of free air was defined as any air pocket greater than 10.0 cm. Results: Among patients with free air, the predominant causes were perforated viscus (41%) and postoperative (<8 days) residual air (37%). For patients with visceral perforation, only 45% had free air on imaging studies, and for these patients, the predominant cause was peptic ulcer (16%), diverticulitis (16%), trauma (14%), malignancy (14%), bowel ischemia (10%), appendicitis (6%), and endoscopy (4%). The likelihood that free air was identified on an imaging study by lesion was 72% for perforated peptic ulcer, 57% for perforated diverticulitis, but only 8% for perforated appendicitis. The origin of massive free air was equally likely to be gastroduodenal, small bowel, or colonic perforation. Conclusion: The cause of free air when surgical pathology is the source has substantially changed from previous reports. Level of Evidence: Epidemiologic study, level IV.
AB - Background: We sought to determine the origin of free intraperitoneal air in this era of diminishing prevalence of peptic ulcer disease and imaging studies. In addition, we attempted to stratify the origin of free air by the size of the air collection. Methods: We queried our hospital database for "pneumoperitoneum" from 2005 to 2007 and for proven gastrointestinal perforation from 2000 to 2007. Massive amount of free air was defined as any air pocket greater than 10.0 cm. Results: Among patients with free air, the predominant causes were perforated viscus (41%) and postoperative (<8 days) residual air (37%). For patients with visceral perforation, only 45% had free air on imaging studies, and for these patients, the predominant cause was peptic ulcer (16%), diverticulitis (16%), trauma (14%), malignancy (14%), bowel ischemia (10%), appendicitis (6%), and endoscopy (4%). The likelihood that free air was identified on an imaging study by lesion was 72% for perforated peptic ulcer, 57% for perforated diverticulitis, but only 8% for perforated appendicitis. The origin of massive free air was equally likely to be gastroduodenal, small bowel, or colonic perforation. Conclusion: The cause of free air when surgical pathology is the source has substantially changed from previous reports. Level of Evidence: Epidemiologic study, level IV.
KW - Free intraperitoneal air
KW - peptic ulcer perforation
KW - perforated diverticulitis
KW - pneumoperitoneum
KW - viscus perforation
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U2 - 10.1097/TA.0b013e31825c157f
DO - 10.1097/TA.0b013e31825c157f
M3 - Review article
C2 - 22929483
AN - SCOPUS:84865968373
VL - 73
SP - 542
EP - 548
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
SN - 2163-0755
IS - 3
ER -