Tension pneumoperitoneum: a very rare complication of acute gangrenous appendicitis

Tension pneumoperitoneum is a very rare consequence of acute gangrenous appendicitis. We report a case of a 32-year-old woman who presented with abdominal pain, progressively increasing abdominal distension, profound hemodynamic instability and ventilatory compromise. The diagnosis of tension pneumo...

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Bibliographic Details
Published in:Annals of the Royal College of Surgeons of England 2016-11, Vol.98 (8), p.e197-e199
Main Authors: Das, P, Mukherjee, R, Pathak, D, Gangopadhyay, A, Halder, S, Singh, S K
Format: Article
Language:English
Subjects:
Abdomen
Abdominal Pain - etiology
Acute Disease
Adult
Appendectomy
Appendicitis
Appendicitis - complications
Appendicitis - surgery
Cardiac arrhythmia
Decompression, Surgical - methods
Edema
Female
Gangrene - complications
Gastrointestinal surgery
Humans
Intra-Abdominal Hypertension - etiology
Intra-Abdominal Hypertension - surgery
Medical imaging
Online Case Report
Ostomy
Pneumoperitoneum - diagnostic imaging
Pneumoperitoneum - etiology
Pneumoperitoneum - surgery
Thrombosis
Tomography, X-Ray Computed
Trauma
Veins & arteries
Ventilation
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Summary:Tension pneumoperitoneum is a very rare consequence of acute gangrenous appendicitis. We report a case of a 32-year-old woman who presented with abdominal pain, progressively increasing abdominal distension, profound hemodynamic instability and ventilatory compromise. The diagnosis of tension pneumoperitoneum was confirmed by computed tomography, which showed compression of the intra-abdominal viscera and liver (saddlebag sign) by a large volume of intraperitoneal free air. Urgent needle decompression was done as an emergency measure. Exploratory laparotomy, planned due to persistent peritonitis, revealed gangrenous appendicitis with perforation near its base. Appendicectomy with excision of gangrenous portion of caecum was performed. The purpose of the reporting this case is to highlight that the tension pneumoperitoneum can be, very rarely, associated with gangrenous appendicitis and timely diagnosis is very important for the emergency management of this deadly condition.
ISSN:0035-8843
1478-7083
DOI:10.1308/rcsann.2016.0240