Anatomical alterations secondary to childbirth or previous abdominal surgery, as in this case, could favor the appearance of pneumoperitoneum. If the pressure continues, the air enters the retroperitoneum and the subcutaneous cell tissue 7 through dissection of muscle planes and diaphragm defects that lead to the contact between the retroperitoneal and pleural cavities. Several authors have demonstrated in animal models that after the rupture of distended alveoli, the gas that is released dissects pleural bullas and penetrates the pleural space. It has been accepted that the most probable origin of this air is the lungs. 2 As for the mechanism by which the gas reaches the peritoneum in the absence of organ perforation, many theories have been postulated. 1–6 Perforation of a hollow organ should first be suspected as it is frequently the origin of pneumoperitoneum, since less than half of perforated patients show signs of peritoneal irritation. There are few reports in the literature about pneumoperitoneum associated with diving incidents, including only 9 cases published since 1977. At the 60-day follow-up visit, we observed complete resolution of his symptoms. When the patient was discharged after 30 days under observation, he was asymptomatic, with normal lab work and radiological persistence of the pneumoperitoneum, although much less than when he was first hospitalized. He presented isolated fever (38.1 ☌) on the third day after hospitalization, which responded to the administration of an antipyretic. During hospitalization, the patient passed gas and had normal bowel movements with no pathologic production. Oral tolerance was started 48 h later, and enteral nutrition was reinstated without complications after 72 h. Given the good general status of the patient, the lack of significance found in the analyses and the lack of evidence of perforation, we opted for conservative management with no oral intake, parenteral nutrition, normobaric high-flow oxygen therapy (MV at 35%–8 lpm) and low-molecular-weight heparin at a prophylactic dosage.
#Barotrauma meaning free
No intraperitoneal free fluid, intravascular gas or disruption of hollow organs was observed. In addition to the voluminous pneumoperitoneum pushing the abdominal content in the posterior direction and umbilical hernia with fat and gas content, thoracoabdominal CT also revealed pulmonary laminar atelectasis due to compression and minimal pericardial effusion. 1 and 2), a normal intraluminal hydro-air pattern was seen with extraluminal free air accumulated in the subdiaphragm region as well as displacement of the lung bases and viscera of the upper abdomen. When we observed the shape of the transverse colon wall on standing chest and abdominal radiographs ( Figs. The remaining determinations, including coagulation and venous blood gases, had values within normal ranges.
The remaining physical exploration was unremarkable.īlood analysis showed 14,490 leukocytes (normal formula), GOT 53 U/l, GPT 74 U/l, CPK 208 U/l, CKMB 40 U/l and myoglobin 46.49 ng/ml. The patient had no pain during abdominal palpation or any signs of peritoneal irritation. The abdomen was soft, with great distension and generalized hyperresonance as well as crepitus upon palpation of the umbilical region, which presented a non-complicated umbilical hernia. On physical examination, the patient was in good general condition: no fever, hemodynamically stable and eupneic. His personal history included left inguinal hernioplasty. The distension had begun immediately after free-diving to a depth of 39 m. We present the case of a 35-year-old male patient who came to our consultation with abdominal distension that had been developing over the previous 10 h, with no other symptoms.
0 kommentar(er)
