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Peritoneal free air due to evacuation of pneumobilia in blunt abdominal trauma.

Howley I, Gregg SC, Heffernan DS, Adams CA - J Emerg Trauma Shock (2010)

Bottom Line: Pneumobilia is mostly observed on computed tomography (CT) following surgical biliary-enteric anastomosis and biliary manipulation through endoscopic procedures.Although pneumobilia can be seen in pathological conditions, post-surgical pneumobilia is typically not associated with morbidity.Given that the subsequent laparotomy proved to be non-therapeutic, this report adds to the few cases of intra-peritoneal free air not helped by surgical intervention.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Rhode Island Hospital and the Warren Alpert School of Medicine, Brown University, Providence, RI 02903, USA.

ABSTRACT
Pneumobilia is mostly observed on computed tomography (CT) following surgical biliary-enteric anastomosis and biliary manipulation through endoscopic procedures. Although pneumobilia can be seen in pathological conditions, post-surgical pneumobilia is typically not associated with morbidity. In the present article, we report a case in which blunt abdominal trauma led to the evacuation of pre-existing pneumobilia causing pneumoperitoneum. Given that the subsequent laparotomy proved to be non-therapeutic, this report adds to the few cases of intra-peritoneal free air not helped by surgical intervention.

No MeSH data available.


Related in: MedlinePlus

CT scan of the abdomen on patient presentation demonstrating pneumobilia and pneumoperitoneum anterior to the liver
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Figure 0002: CT scan of the abdomen on patient presentation demonstrating pneumobilia and pneumoperitoneum anterior to the liver

Mentions: Laboratory examination revealed the following: WBC 15.3 × 103/mm3, hemoglobin 11.3 g/dL, Aspartate aminotransferase (AST) 1698 U/L, alanine transaminase (ALT) 783 U/L, alkaline phosphatase 376 U/L, total bilirubin 1.2 mg/dL, direct bilirubin 0.4 mg/dL, albumin 3.1 g/dL, and troponin 0.19 ng/mL. Her chest X-ray, head computerized tomography (CT), and cervical spine CT examinations were negative for any acute injuries. A CT of her abdomen and pelvis at this admission showed a large amount of pneumobilia, moderate amount of peritoneal free air around the liver, perihepatic free fluid, and an American Association for the Surgery of Trauma (AAST) grade II liver laceration[1] to the dome of the right lobe of the liver [Figure 2]. There was no evidence for pneumothorax on the CT scan. Given the patient’s mechanism, abdominal tenderness, and CT findings, our major concerns included hollow viscus injury. As such, we proceeded to the operating room for an exploratory laparotomy.


Peritoneal free air due to evacuation of pneumobilia in blunt abdominal trauma.

Howley I, Gregg SC, Heffernan DS, Adams CA - J Emerg Trauma Shock (2010)

CT scan of the abdomen on patient presentation demonstrating pneumobilia and pneumoperitoneum anterior to the liver
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2966580&req=5

Figure 0002: CT scan of the abdomen on patient presentation demonstrating pneumobilia and pneumoperitoneum anterior to the liver
Mentions: Laboratory examination revealed the following: WBC 15.3 × 103/mm3, hemoglobin 11.3 g/dL, Aspartate aminotransferase (AST) 1698 U/L, alanine transaminase (ALT) 783 U/L, alkaline phosphatase 376 U/L, total bilirubin 1.2 mg/dL, direct bilirubin 0.4 mg/dL, albumin 3.1 g/dL, and troponin 0.19 ng/mL. Her chest X-ray, head computerized tomography (CT), and cervical spine CT examinations were negative for any acute injuries. A CT of her abdomen and pelvis at this admission showed a large amount of pneumobilia, moderate amount of peritoneal free air around the liver, perihepatic free fluid, and an American Association for the Surgery of Trauma (AAST) grade II liver laceration[1] to the dome of the right lobe of the liver [Figure 2]. There was no evidence for pneumothorax on the CT scan. Given the patient’s mechanism, abdominal tenderness, and CT findings, our major concerns included hollow viscus injury. As such, we proceeded to the operating room for an exploratory laparotomy.

Bottom Line: Pneumobilia is mostly observed on computed tomography (CT) following surgical biliary-enteric anastomosis and biliary manipulation through endoscopic procedures.Although pneumobilia can be seen in pathological conditions, post-surgical pneumobilia is typically not associated with morbidity.Given that the subsequent laparotomy proved to be non-therapeutic, this report adds to the few cases of intra-peritoneal free air not helped by surgical intervention.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Rhode Island Hospital and the Warren Alpert School of Medicine, Brown University, Providence, RI 02903, USA.

ABSTRACT
Pneumobilia is mostly observed on computed tomography (CT) following surgical biliary-enteric anastomosis and biliary manipulation through endoscopic procedures. Although pneumobilia can be seen in pathological conditions, post-surgical pneumobilia is typically not associated with morbidity. In the present article, we report a case in which blunt abdominal trauma led to the evacuation of pre-existing pneumobilia causing pneumoperitoneum. Given that the subsequent laparotomy proved to be non-therapeutic, this report adds to the few cases of intra-peritoneal free air not helped by surgical intervention.

No MeSH data available.


Related in: MedlinePlus