A Case of Idiopathic Pneumoperitoneum Requiring Emergency Decompression of the Abdominal Cavity Due to Increased Intra-abdominal Pressure

Abstract

We report a rare case of idiopathic pneumoperitoneum that required emergency decompression of the abdominal cavity due to increased intra-abdominal pressure. A 57-year-old male patient injured in a motorcycle accident was transported to our hospital. His respiratory condition was poor, with a respiratory rate of 24/min and SpO₂ of 93% (O₂ 10 L/min.); there was subcutaneous emphysema and a flail chest on the right side. Chest CT revealed multiple fractures of the right 2nd to 7th ribs and traumatic hemopneumothorax. We performed tracheal intubation and initiated the patient on positive pressure ventilation. The day after admission, we performed thoracoplasty with rib plate fixation and pulmonary suture. CT performed on the day of the surgery showed a large amount of free air in the abdominal cavity. There were no findings suggestive of gastrointestinal perforation, but as the abdomen was tense and the intravesical pressure was high (19 mmHg), we performed emergency decompression of the abdomen. The patient was extubated on the 4th postoperative day and transferred to another hospital for rehabilitation on the 31st postoperative day. While idiopathic pneumoperitoneum resulting in increased intra-abdominal pressure has not been reported in the past, early intervention may be required to avoid abdominal compartment syndrome.