Identifying Pathological Pneumoperitoneum After Laparoscopic Surgery
Journal Title: Turkish Journal of Colorectal Disease - Year 2021, Vol 31, Issue 1
Abstract
Aim: The study aims to analyze the frequency and extent of pneumoperitoneum after laparoscopic surgery and to differentiate routine post laparoscopy pneumoperitoneum from pneumoperitoneum due to possible bowel perforation. Method: Pneumoperitoneum after laparoscopic surgery persists for a variable number of days and can mask pathological pneumoperitoneum due to the complication of bowel perforation at laparoscopic surgery. This study aims to find a simple radiological solution to this issue, so that pathological bowel perforation can be detected at the earliest and corrective action taken. Results: We had four cases of bowel perforation after laparoscopic surgery, and, the clinical signs were subtle and not clearly indicating any peritonitis. Radiological tests on post operative day 1were inconclusive, as free gas was attributed to persisting carbon dioxide pneumoperitoneum. Hence a relook laparoscopy was delayed for 48 hrs ,when clinical signs were obvious. This scenario presented a challenge to distinguish persisting carbon dioxide pneumoperitoneum post laparoscopy from pathological pneumoperitoneum. Conclusion: We decided to measure by X-ray chest the width of gas under diaphragm in the usual laparoscopic procedures, on the first post operative day and compare this with the width of gas under diaphragm in the four cases of iatrogenic bowel perforation post laparoscopic surgery. It was found that iatrogenic bowel perforation at laparoscopy is characterized by a wider gas under diaphragm, with the width at widest point ranging from 1.5 cms to 2.0 cms. Hence a simple xray chest could raise suspicion of a bowel perforation complication , and dictate further investigations like computed tomography scan or relook laparoscopy at the earliest post operative period.
Authors and Affiliations
K G Mathew, Faris Alaswad, Saajan Ignatius Pius
Keywords
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- DOI 10.4274/tjcd.galenos.2020.2020-6-5
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