1/6. tracheoesophageal fistula and massive pneumoperitoneum after prolonged mechanical ventilation.We describe a patient who had two unusual complications of prolonged mechanical ventilation-tracheoesophageal fistula and pneumoperitoneum-with a fatal outcome. Recurrent pulmonary aspirations and massive abdominal distention in the setting of longstanding artificial ventilation should alert the physician to these possibilities.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. Massive pneumoperitoneum after scuba diving.pneumoperitoneum usually indicates rupture of a hollow viscus and considered a surgical emergency. But air may also enter the peritoneum from the lung or the genital organs in female without visceral perforation. While scuba diving, the rapid ascent is usually controlled by placing in a decompression chamber and the excess gas volume is exhaled. Failure to allow this excess gas to escape will result in overdistension of air passage, which may rupture resulting in pulmonary interstitial emphysema or, if air enters the circulation, air embolus can occur. Pneumo-peritoneum is a rare complication of diving accidents. While the majority of cases are not related to an intraabdominal catastrophy, more than 20% have been the result of gastric rupture. We report a 42-yr-old male patient with massive pneumoperitoneum after scuba diving, who presented himself with dyspnea and abdominal distension. knowledge of this rare condition and its benign course may allow the emergency physician and surgeon to order appropriate studies to help avoid unnecessary surgical treatment. It is important to determine promptly whether the air emanated from a ruptured viscus or was introduced from an extraperitoneal source. Free air in the abdomen does not always indicate a ruptured intra-abdominal viscus.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/6. pneumoperitoneum after diving--two clinical cases and literature review.pneumoperitoneum after diving is a rare symptom. diagnosis and treatment strongly depends on the primary source of the air in the abdominal cavity. There are two main sources of air entering the perineum: perforation of the gastrointestinal tract and pulmonary barotrauma. The management is different and additionally, in both cases, the decompression sickness and arterial gas embolism as consequences of inappropriate decompression phase of the diving should be included in the clinical diagnosis and treatment. The multidisciplinary team including hyperbaric physicians and surgeons is necessary for proper management of such cases. In this paper two cases of pneumoperitoneum of different origins are presented and similar cases reported in the literature are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/6. intestinal perforation due to cytomegalovirus infection in patients with AIDS.intestinal perforation due to cytomegalovirus (CMV) infection in patients with AIDS is the most common life-threatening condition requiring emergency celiotomy in these patients. The authors describe a patient with AIDS with intestinal perforation due to CMV infection, and review 14 additional cases reported in the English-language surgical literature. The diagnostic triad of pneumoperitoneum on x-ray, evidence or history of CMV infection, and AIDS occurred in 70 percent of patients. The most common site of intestinal perforation was the colon (53 percent), followed in frequency by the distal ileum (40 percent) and appendix (7 percent); perforation usually occurred between the distal ileum and splenic flexure of the colon. colonoscopy, rather than sigmoidoscopy, is recommended as a screening examination in patients with AIDS suspected of having colonic ulceration due to CMV infection. Multiple biopsies of ulcerated tissue should be obtained. Gross and microscopic analyses of involved intestinal tissue reveal the characteristic findings of ulceration and CMV infection. Despite aggressive therapy, the operative mortality rate in patients with AIDS with intestinal perforation due to CMV infection was 54 percent and the overall mortality rate was 87 percent. postoperative complications occurred in most patients and consisted mainly of systemic sepsis and pneumonia caused by pneumocystis carinii infection. An increased awareness of this syndrome by physicians frequently called on to manage patients with AIDS is recommended.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/6. Spontaneous pneumothoraces, pneumomediastinum, and pneumoperitoneum: consequences of smoking crack cocaine.The combination of pneumothoraces, pneumomediastinum, and pneumoperitoneum is a rare consequence of smoking crack cocaine. This is a report of this trilogy of findings in a 17-year-old girl who attempted suicide by smoking crack cocaine. This case is important to the emergency physician because the increase in crack cocaine use among the adolescent population.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/6. Nonsurgical causes of pneumoperitoneum.The radiographic manifestation of free air in the peritoneal cavity suggests serious intra-abdominal disease and the need for urgent surgical management. Yet, about 10% of all cases of pneumoperitoneum are caused by physiologic processes that do not require surgical management. We retrospectively reviewed cases of nonsurgical causes of pneumoperitoneum at the 2 teaching hospitals of a university medical center between January 1990 and December 1995. Successful management by observation and supportive care without surgical intervention was defined as the diagnostic feature of nonperforation. Failure of a laparotomy to delineate a surgical cause or to result in a reparative procedure is congruent with a nonsurgical cause of pneumoperitoneum. During this period, 8 patients (6 men and 2 women; mean age, 61 years) were identified with nonsurgical causes of pneumoperitoneum. Two patients underwent negative laparotomy, and the other 6 were successfully managed nonoperatively and discharged from the hospital. In 6 patients, a cause of the pneumoperitoneum was identified. The causes may be grouped under the following categories: postoperatively retained air, thoracic, abdominal, gynecologic, and idiopathic. In our review of the literature, 61 of 139 reported cases underwent surgical treatment without evidence of perforated viscus. To avoid unnecessary surgical procedures, both primary medicine physicians and surgeons need to recognize nonsurgical causes of pneumoperitoneum. Conservative management is warranted in the absence of symptoms and signs of peritonitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |