Case Report
Copyright ©2012 Baishideng. All rights reserved.
World J Gastrointest Surg. Jun 27, 2012; 4(6): 152-156
Published online Jun 27, 2012. doi: 10.4240/wjgs.v4.i6.152
Postoperative pneumoperitoneum after colorectal surgery: Expectant vs surgical management
Natalia Spinelli, Valentine Nfonsam, Jorge Marcet, Vic Velanovich, Jared C Frattini
Natalia Spinelli, Valentine Nfonsam, Jorge Marcet, Vic Velanovich, Jared C Frattini, Department of Surgery, University of South Florida College of Medicine, Suite F-145 Tampa, FL 33606, United States
Author contributions: Spinelli N and Frattini JC contributed equally to this work; Spinelli N and Frattini JC performed the research; Nfonsam V, Marcet J and Velanovich V analyzed the data; Spinelli N and Frattini JC wrote the paper.
Correspondence to: Jared C Frattini, MD, Department of Surgery, University of South Florida College of Medicine, One Tampa General Circle, Suite F-145, Tampa, FL 33606, United States. jcfratt@yahoo.com
Telephone: +1-813-8444545 Fax: +1-813-8447396
Received: June 19, 2011
Revised: June 18, 2012
Accepted: June 23, 2012
Published online: June 27, 2012
Abstract

Postoperative pneumoperitoneum poses a clinical dilemma. Depending on the cause, its management includes a spectrum from simple observation and supportive care to surgical exploration. The aim of this paper is to present four clinical cases and propose an algorithm for the management of postoperative pneumoperitoneum based on available literature. The causes, diagnosis and possible complications arising from pneumoperitoneum will also be discussed. Three of the four cases presented were successfully managed conservatively and one had an exploratory laparotomy with negative findings. In such scenarios, it is important to consider the nonsurgical causes of pneumoperitoneum, which include pseudopneumoperitoneum, thoracic, abdominal, gynecological and idiopathic. These causes do not always require emergent exploratory laparotomy. The surgical team needs to consider the history, physical exam and diagnostic workup of the patient. If a patient presents with peritoneal signs, then exploratory laparotomy is a must. Since 10% of the cases of pneumoperitoneum are caused by nonsurgical entities, managed expectantly, a negative exploratory laparotomy and its associated risks are avoided.

Keywords: Postoperative pneumoperitoneum, Free air under diaphragm, Colorectal surgery, Benign pneumoperitoneum, Spontaneous pneumoperitoneum