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Content Update: Post-operative Pneumoperitoneum April 2020

Patients undergoing laparoscopic and open abdominal surgery have residual intra-abdominal pneumoperitoneum for varying amounts of time after surgery. Post-operative patients presenting to the ED with abdominal or chest pain may have pneumoperitoneum discovered on CT scanning or upright chest radiographs.  Differentiating normal,  from pathologic pneumoperitoneum related to perforation or anastomotic failure,  can be difficult.  Free air may be pathologic if the patient is more than 3-5 days post-op, if there is a large amount of air, or if the patient has evidence of peritoneal irritation, fever, or leukocytosis (1,2,3). For such patients consult surgery to help determine the next steps.

(1) Malgras, B  et al 'Natural History of Pneumoperitoneum after Laparotomy: findings on multidetector-row computed tomography' World Journal of Surgery 41.1 (2017):56-63  PMID 27456496(2) Gayer, G et al 'Post-operative Pneumoperitoneum as Detected by CT: Prevalence, duration, and relevant factors affecting its possible significance' AbdomImaging (2000) 25:301-305  doi:10.1007/s002610000036(3) Bernstein L et al 'Postoperative Pneumoperitoneum: Clearing the Air' J Surg (Jan, 2014):2 (1), 4.

INTRODUCTION

Outpatient surgical procedures are common, and with increasing pressure for cost containment, admitted patients are being discharged earlier in their postoperative course. As a result, more patients are coming to the ED with postoperative fever, respiratory complications, GU complaints, wound infections, vascular problems, and complications of drug therapy (Table 87-1). This chapter reviews the complications common to all surgical procedures and those specific to a specific procedure.

TABLE 87-1Complications of General Surgical Procedures

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