Tension pneumoperitoneum in two pediatric patients

Abstract

Introduction: Tension pneumoperitoneum is a serious and rare clinical condition that generates a sudden increase in intra-abdominal pressure, which causes marked hemodynamic instability and respiratory failure.

Presentation: Two pediatric patients aged 7 months and 8 years were treated at the Emergency Department of the Américo Boavida Hospital in Luanda, Angola, as they presented severe hemodynamic and respiratory alterations, great abdominal distension, tympanism and positive Jobert's sign. Physical examination and abdominal radiography results confirmed the diagnosis of tension pneumoperitoneum. The clinical emergency required to decrease the intra-abdominal pressure immediately through a percutaneous abdominal decompression. Hollow viscera perforations were found using exploratory laparotomy. Blood and stool cultures were positive for Salmonella Typhi. Specific treatment was with ceftriaxone, metronidazole and gentamicin. All cases presented a favorable clinical evolution.

Conclusions: It is essential to be familiar with tension pneumoperitoneum, as a serious clinical complication. It is a very infrequent event and due to the severe hemodynamic alterations, it causes, it requires emergency medical attention. It is important to achieve a rapid diagnosis, based on clinical data and through imaging techniques, in order to achieve an adequate immediate treatment.