1Farheen Raza, 1Khalid Shakeel Babar, 1Maria Rauf, 1Sadia Babar, 1Bilqees Yawar Faiz
1Shifa International Hospital, Islamabad, Pakistan
Pneumoperitoneum refers to presence of free intraperitoneal air. There are many causes of pneumoperitoneum including spontaneous, iatrogenic and viscus perforation. For decades laparotomy has remained the standard surgical approach for management of pneumoperitoneum in symptomatic patients. We present an alternate minimally invasive approach for managing pneumoperitoneum by reporting an unusual case of 26 years old female patient who underwent surgery for excision of tubo-ovarian mass. Post surgery she developed intestinal obstruction. Her laparotomy was performed to relieve obstruction that revealed complex adhesions complicating the surgery. Later on the patient developed pneumoperitoneum secondary to bowel perforation. Patient had severe abdominal discomfort and respiratory distress. Her imaging findings were consistent with moderate to tension pneumoperitoneum. Clinically the patient was rendered unfit for major surgery due to significantly low hemoglobin. Therefore, a non-surgical mode was opted and her pneumoperitoneum was decompressed under ultrasound guidance by needle aspiration using 18 G IV cannula in radiology department. The bar code pattern on ultrasound was used as a guide to assess pneumoperitoneum. Patient tolerated the procedure well and had significant relief in her symptoms. Surgical correction of cause of pneumoperitoneum is the main stay of management. However, needle aspiration of pneumoperitoneum is novel approach to relieve symptoms till other options of surgery are available to patient in cases of tension pneumoperitoneum. Subsequently, our patient underwent successful laparotomy and surgery to repair the site of perforation.