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Blunt trauma resulting in pneumothorax with progression to pneumoperitoneum: a unique diagnosis with predicament in management.

Curfman KR, Robitsek RJ, Sammett D, Schubl SD - J Surg Case Rep (2015)

Bottom Line: The patient is an 82-year-old male who was brought into the emergency department after being found at the bottom of a flight of stairs with a bleeding scalp laceration.Upon presentation, the patient underwent emergent intubation followed by tube thoracostomy placement, had necessary imaging and was transferred to the surgical intensive care unit (SICU).He was taken to the operating room for suspected viscus perforation, though none was found after extensively searching during an exploratory laparotomy.

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Affiliation: Ross University School of Medicine, Dominica, West Indies.

No MeSH data available.


Related in: MedlinePlus

Adaptation of the algorithm initially proposed by Hoover et al. [10] for managing spontaneous pneumoperitoneum.
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RJV147F4: Adaptation of the algorithm initially proposed by Hoover et al. [10] for managing spontaneous pneumoperitoneum.

Mentions: Diagnosis of pneumoperitoneum is often only possible with imaging, initially on plain radiographs or by CT scans [9]. Patients with spontaneous pneumoperitoneum often undergo emergency laparotomy as a reflex response. Some have advanced the idea of nonsurgical treatment of spontaneous pneumoperitoneum in the absence of a pathological condition that necessitates surgical exploration. Hoover et al. produced an algorithm suggesting proper management of spontaneous pneumoperitoneum (Fig. 4), basing their primary recommendations for management on radiologic imaging, temperature, leukocyte count and physical examination [10]. Our patient was hypothermic, had a leukocyte count within normal limits and was unresponsive, so a proper abdominal examination could not be performed. Per this algorithm surgical exploration was not initially warranted and he should have been observed. However, our patient had worsening hypotension, tachycardia, hypothermia, tachypnea, acidosis with high anion gap and hypokalemia, and we felt it was pertinent to progress to laparotomy due to his decline in status. Though laparotomy did not reveal any perforations, the patient's vital signs normalized postoperatively over the next 24 h.Figure 4:


Blunt trauma resulting in pneumothorax with progression to pneumoperitoneum: a unique diagnosis with predicament in management.

Curfman KR, Robitsek RJ, Sammett D, Schubl SD - J Surg Case Rep (2015)

Adaptation of the algorithm initially proposed by Hoover et al. [10] for managing spontaneous pneumoperitoneum.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664951&req=5

RJV147F4: Adaptation of the algorithm initially proposed by Hoover et al. [10] for managing spontaneous pneumoperitoneum.
Mentions: Diagnosis of pneumoperitoneum is often only possible with imaging, initially on plain radiographs or by CT scans [9]. Patients with spontaneous pneumoperitoneum often undergo emergency laparotomy as a reflex response. Some have advanced the idea of nonsurgical treatment of spontaneous pneumoperitoneum in the absence of a pathological condition that necessitates surgical exploration. Hoover et al. produced an algorithm suggesting proper management of spontaneous pneumoperitoneum (Fig. 4), basing their primary recommendations for management on radiologic imaging, temperature, leukocyte count and physical examination [10]. Our patient was hypothermic, had a leukocyte count within normal limits and was unresponsive, so a proper abdominal examination could not be performed. Per this algorithm surgical exploration was not initially warranted and he should have been observed. However, our patient had worsening hypotension, tachycardia, hypothermia, tachypnea, acidosis with high anion gap and hypokalemia, and we felt it was pertinent to progress to laparotomy due to his decline in status. Though laparotomy did not reveal any perforations, the patient's vital signs normalized postoperatively over the next 24 h.Figure 4:

Bottom Line: The patient is an 82-year-old male who was brought into the emergency department after being found at the bottom of a flight of stairs with a bleeding scalp laceration.Upon presentation, the patient underwent emergent intubation followed by tube thoracostomy placement, had necessary imaging and was transferred to the surgical intensive care unit (SICU).He was taken to the operating room for suspected viscus perforation, though none was found after extensively searching during an exploratory laparotomy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Ross University School of Medicine, Dominica, West Indies.

No MeSH data available.


Related in: MedlinePlus