Postoperative pneumoperitoneum in children: two clinical cases as an example

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BACKGROUND: The literature describes various causes of free gas in the abdominal cavity, or pneumoperitoneum, in the immediate postoperative period. In such cases, surgeons should find out if the residual gas is postoperative pneumoperitoneum, or it is some postoperative complication requiring surgical intervention. In the present article, the authors describe two clinical cases of pneumoperitoneum in children after elective surgeries.

CLINICAL CASE DESCRIPTION: First case: free gas was fund in a 6-year-old child at ultrasound examination and overview radiography of the abdominal organs. Perforation of some hollow organ was suspected. After conservative measures (infusion therapy with glucose-salt solution, anesthesia, cleansing enema), which did not give any positive dynamics, diagnostic laparoscopy was performed. No perforation in genital organs was detected. On the second postoperative day, the child was discharged in the satisfactory state.

Second case: ultrasound examination and overview radiography of the abdominal organs revealed free gas under the diaphragm dome in a 13-year-old patient. Taking into account the clinical picture and instrumental diagnostic findings, diagnostic laparoscopy was performed which revealed swollen intestinal loops without signs of perforation. The child was discharged on the third postoperative day. Control ultrasound examination of the abdominal cavity organs showed no any free gas; in the left iliac region, moderate edematous tissue 1×1.5 cm was seen.

CONCLUSION: Dynamic monitoring of patients with postoperative pneumoperitoneum and without signs of peritonitis should be performed. If there is no positive dynamics in child’s condition, diagnostic laparoscopy or laparotomy are recommended.

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作者简介

Ulviya Yusifova

The Russian National Research Medical University named after N.I. Pirogov

编辑信件的主要联系方式.
Email: u.yusifova.u@mail.ru
ORCID iD: 0000-0001-5032-5741

MD

俄罗斯联邦, 9 block 4, build. 1 Geroev Panfilovtsev street, 125480 Moscow

Madina Chundokova

The Russian National Research Medical University named after N.I. Pirogov; Filatov N.F. Children's City Hospital

Email: cmadina@yandex.ru
ORCID iD: 0000-0002-5080-4838

MD, Dr. Sci. (Medicine), Assoc. Professor

俄罗斯联邦, 9 block 4, build. 1 Geroev Panfilovtsev street, 125480 Moscow; Moscow

Maxim Golovanev

The Russian National Research Medical University named after N.I. Pirogov; Filatov N.F. Children's City Hospital

Email: aesculap2001@mail.ru
ORCID iD: 0000-0002-5512-9894

MD, Cand. Sci. (Medicine), Assoc. Professor

俄罗斯联邦, 9 block 4, build. 1 Geroev Panfilovtsev street, 125480 Moscow; Moscow

Konstantin Ushakov

The Russian National Research Medical University named after N.I. Pirogov; Filatov N.F. Children's City Hospital

Email: Kaskodlol@mail.ru
ORCID iD: 0000-0003-2927-8092
SPIN 代码: 8997-5308

MD

俄罗斯联邦, 9 block 4, build. 1 Geroev Panfilovtsev street, 125480 Moscow; Moscow

Olga Dondup

The Russian National Research Medical University named after N.I. Pirogov

Email: odondup@gmail.com
ORCID iD: 0000-0002-4307-6246

MD

俄罗斯联邦, 9 block 4, build. 1 Geroev Panfilovtsev street, 125480 Moscow

参考

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  2. Breen ME, Dorfman M, Chan SB. Pneumoperitoneum without peritonitis: A case report. Am J Emergency Med. 2008;26(7):841.e1–841.e2. doi: 10.1016/j.ajem.2008.01.040
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  4. Ng CS, Watson CJ, Palmer CR, et al. Evaluation of early abdominopelvic computed tomography in patients with acute abdominal pain of unknown cause: Prospective randomised study. BMJ. 2002;325(7377):1387. doi: 10.1136/bmj.325.7377.1387
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  6. Ramakrishnan VM, Niemann T, Maletzki P, et al. Quantifying and statistically modeling residual pneumoperitoneum after robotic-assisted laparoscopic prostatectomy: A prospective, single-center, observational study. Diagnostics (Basel). 2022;12(4):785. EDN: NDTHKG doi: 10.3390/diagnostics12040785
  7. Malgras B, Placé V, Dohan A, et al. Natural history of pneumoperitoneum after laparotomy: Findings on multidetector-row computed tomography. World J Surg. 2017;41(1):56–63. doi: 10.1007/s00268-016-3648-1
  8. Nazerian P, Tozzetti C, Vanni S, et al. Accuracy of abdominal ultrasound for the diagnosis of pneumoperitoneum in patients with acute abdominal pain: A pilot study. Crit Ultrasound J. 2015;7(1):15. doi: 10.1186/s13089-015-0032-6
  9. Muñoz-Serrano AJ, Delgado-Miguel C, Velayos M, et al. Postoperative pneumoperitoneum in pediatric patients: Residual air or surgical complication? A prospective study. J Laparoendosc Adv Surg Tech A. 2022;32(5):576–582. EDN: HCGLTJ doi: 10.1089/lap.2021.0680
  10. Peirce GS, Swisher JP, Freemyer JD, et al. Postoperative pneumoperitoneum on computed tomography: Is the operation to blame? Am J Surg. 2014;208(6):949–953; discussion 953. doi: 10.1016/j.amjsurg.2014.09.006
  11. Gayer G, Jonas T, Apter S, et al. Postoperative pneumoperitoneum as detected by CT: Prevalence, duration, and relevant factors affecting its possible significance. Abdom Imaging. 2000;25(3):301–305. EDN: AVKPTJ doi: 10.1007/s002610000036

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2. Fig. 1. Clinical case 1. Overview radiography of the abdominal organs.

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3. Fig. 2. Clinical case 2. Overview radiography of the abdominal organs.

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版权所有 © Yusifova U.I., Chundokova M.A., Golovanev M.A., Ushakov K.V., Dondup O.M., 2024

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