From the Guidelines
The treatment for pneumoperitoneum of the stomach should prioritize early involvement of the surgeon and, if available, a CT scan examination to define the cause and site of perforation, without delaying appropriate treatment, especially in cases of diffuse peritonitis 1. When managing pneumoperitoneum, it's crucial to distinguish between cases that require immediate surgical intervention and those where conservative management might be feasible.
- The presence of free air in the peritoneal cavity often leads to surgical exploration, but a CT scan can provide valuable information on the gastrointestinal perforation site and help predict the resources needed for intervention 1.
- Conservative management could be considered in select cases, depending on the perforation site and absence of signs of peritonitis, but this approach requires close monitoring and prompt surgical intervention if the patient's condition deteriorates.
- The use of broad-spectrum antibiotics, such as piperacillin-tazobactam or a combination of ciprofloxacin and metronidazole, may be part of the conservative management strategy to prevent or treat any associated infection.
- Surgical intervention typically involves an exploratory laparotomy to repair the perforation site and thorough peritoneal lavage, followed by post-operative care that includes continued antibiotics, pain management, and gradual reintroduction of oral intake.
- The choice between conservative management and surgical intervention should be made on a case-by-case basis, considering the patient's overall condition, the severity of the pneumoperitoneum, and the presence of any complications such as peritonitis or sepsis.
From the Research
Treatment for Pneumoperitoneum (Pneumotosis) of the Stomach
The treatment for pneumoperitoneum (pneumotosis) of the stomach depends on the underlying cause and severity of the condition.
- Non-operative management is recommended for most patients, with treatment of underlying illnesses 2.
- Surgery is indicated in cases of acute complications such as perforation, peritonitis, and necrotic bowel 2.
- Computed tomography (CT) can help guide management by identifying the cause of gastric pneumatosis and detecting any extragastric etiology 3.
- Patients with increased inflammatory parameters, signs of sepsis, peritonitis, or bowel perforation may require explorative laparotomy 4.
Management Strategies
- Approximately 50% of patients with pneumatosis can be successfully managed non-operatively 5.
- The combination of pneumatosis intestinalis and portal venous gas may confer a higher mortality rate 5.
- Underlying diseases, such as ischemic infarction of the stomach, should be clarified to apply adequate treatment 6.