PMID: 8913228

Issn Print: 1079-6061

Publication Date: 1996/11/01


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Tension Pneumoperitoneum after Blunt Trauma

John W. Ogle; Edward Klofas

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Excerpt

While prognostically important, free abdominal air is usually hemodynamically insignificant. In rare instances, the gas itself may accumulate under pressure and evolve into a tension pneumoperitoneum (TPP). As with tension pneumothorax (TPT), prompt recognition and decompression can be lifesaving. Although frequently required in resuscitations, artificial ventilation is a risk factor for both TPT and TPP. Overzealous bagging and anatomic derangements may increase ventilation risks in trauma patients. Although relatively rare, when TPP occurs, it is often associated with intermittent positive pressure ventilation. [1,2] After confirming an adequate airway and excluding pneumothorax, emergency personnel should consider TPP in patients who deteriorate while being ventilated. Warning signs include a distended, tympanitic abdomen and subdiaphragmatic free air. Nasogastric decompression will be unsuccessful and clinicians must be prepared to perform immediate decompression when hemodynamic compromise occurs in this setting.
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