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Study of course of Pneumoperitoneum produced in post operative patients by serial erect x-ray of abdomen

Author: 
Dr. Rajesh Kumar, Dr. D. K. Sinha, Dr. Raj Shekhar Sharma, Dr. MD. Habibur Rahman and Dr.MD. Afsar Alam
Subject Area: 
Health Sciences
Abstract: 

PNEUMOPERITONEUM is defined as gas in peritoneal cavity. Most common cause of pneumoperitoneum is laparatomy in post operative patients. Among preoperative patients most common cause is hollow viscus perforation exception is appendicular perforation which generally doesn’t cause pneumoperitoneum. Other causes of pneumoperitoneum are trauma, tumour, burst abdomen etc. The presence of pneumoperitoneum does not always imply hollow viscus perforation in preoperative patients, some non surgical conditions are also associated with pneumoperitoneum. Also in female patients, air from the genital tract may ascend and cause spontaneous pneumoperitoneum. Pneumoperitoneum produced after hollow viscus perforation or after laparotomy generally remains unilateral initially and becomes bilateral due to movement, patients who remain propped up and immobile generally produced unilateral pneumoperitoneum. Certain operative procedures like dividing the falciform ligament also facilitates even distribution of gas under diaphragm. Unilateral air under diaphragm is more likely to lead to certain complications like subphrenic abscess, basal pulmonary collapse, dehiscence of abdominal wound etc. To avoid these complications, measures leading to bilateral distribution of air is to be encouraged and in this respect, free mobility of patients in early post operative period is important. X-Ray erect abdomen is good tool to study pneumoperitoneum and its course overtime along with CECT abdomen, USG abdomen, X-ray left lateral decubitus. CECT is regarded as criterion standard for detection of pneumoperitoneum, but it is expensive in terms of both radiation burden and cost. Due to change in abdominal and thoracic pressure (2:1), air in the peritoneal cavity moves to subphrenic space even in recumbent position. This study shows 62.5% shows resolution of POPP before 48 hours, 85.8% of post laparotomy shows resolution of POPP before 4th post operative day and 96.7%of cases shows resolution of POPP before 7th post operative day. In elective patients without pre-op peritonitis show early resolution of pneumoperitoneum compare to emergency cases who generally present with pre-op peritonitis. Open drain delay resolution of POPP. Increasing amount of POPP shows post operative disruption of continuity of bowel. Prolonged POPP is due to persistence of intraperitoneal infections/collection.

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