Pneumoperitoneum and its association with ruptured abdominal viscus
T. G. Winek, H. S. Mosely, G. Grout and D. Luallin
Department of Surgery, Good Samaritan Hospital, Portland, OR.
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.