Spontaneous Pneumoperitoneum due to Intra-abdominal Drain- A Case Report

Abstract

Pneumoperitoneum is most commonly caused by hollow viscus perforation which requires an emergency surgical intervention. However, this is not always the case. Pneumoperitoneum which is not due to hollow viscus perforation is called Spontaneous or “non-surgical” pneumoperitoneum. Rarely, it can present with peritonitis but non-surgical pneumoperitoneum usually follows a benign course and can be managed conservatively. A case of 53-year-old male, non-smoker, non-alcoholic, hypertensive known to have decompensated chronic liver disease, since one year with portal hypertension and ascites was presented. The patient underwent uneventful laparoscopic cholecystectomy for acute calculous cholecystitis and developed spontaneous pneumoperitoneum due to intra-abdominal drain one week postprocedure. Pneumoperitoneum was successfully managed conservatively. A thorough history, physical examination and imaging are crucial in identifying patients with non-surgical pneumoperitoneum and to prevent unnecessary laparotomies. In present case, pneumoperitoneum was due to intra-abdominal drain which resolved after removing the drain. So, it is of utmost importance to rule out non-surgical causes of pnemoperitoneum, especially in surgeries where drain are kept in-situ.

Keywords

• computerized tomography
• decompensated liver disease
• non-surgical pneumoperitoneum
• secondary bacterial peritonitis