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Article |

Pneumoperitoneum and Its Association With Ruptured Abdominal Viscus

Thomas G. Winek, MD; H. Steven Mosely, MD; Gordon Grout, MD; David Luallin, MD
Arch Surg. 1988;123(6):709-712. doi:10.1001/archsurg.1988.01400300051008.
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• Pneumoperitoneum is not invariably associated with ruptured or perforated intra-abdominal viscus. To determine the incidence of free air associated with intra-abdominal viscus perforation, the medical records of 77 consecutive patients whose discharge or autopsy diagnosis included pneumoperitoneum or perforated viscus at a community hospital were retrospectively reviewed between June 1980 and October 1985. Abdominal viscus perforation, as determined by contrast studies or at operation, was not invariably associated with free air. Sixty-nine percent (23/33) of gastroduodenal, 30% (3/10) of small-bowel, and 37% (11/30) of large-bowel perforations had free air, as determined by preoperative x-ray film. Four cases with a total of six episodes of pneumoperitoneum were identified where viscus perforation was not documented. Pneumoperitoneum thus remains a reliable sign of viscus perforation; however, lack of this finding does not rule out perforation, and unusual causes must be considered.

(Arch Surg 1988;123:709-712)


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