Recognizing and Managing the Various Etiologies of Pneumoperitoneum

Pneumoperitoneum is defined as free air in the peritoneal cavity. Most commonly it is caused by the perforation of hollow organs, such as those along the gastrointestinal tract. Perforations may occur anywhere along the GI tract and have various causes including those secondary to infection, inflammation, malignancy, or penetrating trauma. Less commonly, pneumoperitoneum may occur without perforation. Etiologies for such cases include, barotrauma due to mechanical ventilation, CPR, or blunt trauma. With any cause, pneumoperitoneum rarely progresses to tension pneumoperitoneum, which presents with acute abdominal distention, respiratory distress, venous congestion, and aortic occlusive symptoms. Plain film radiography and computed tomography are both highly utilized in detecting pneumoperitoneum and have various presentations or signs possible. Determining the etiology is important to the healthcare provider as it is essential in determining patient management and treatment. Treatment options range from observation to surgical intervention