SHM Converge Scientific Abstract ePoster Gallery-Spontaneous Pneumoperitoneum Causing Abdominal Compartment Syndrome

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This case report describes a 60-year-old man who presented after a syncopal episode with hypoxemia, tachycardia, abdominal distension, and unresponsiveness. In the emergency department, he developed seizure-like activity and required intubation. Imaging showed large-volume pneumoperitoneum, multiple segmental pulmonary emboli, and bilateral lower-lobe consolidations, but no evidence of bowel perforation or recent abdominal surgery.<br /><br />The patient rapidly worsened, developing hypotension, elevated peak airway pressures, metabolic acidosis, acute kidney injury, and elevated lactate—findings consistent with hypoperfusion and abdominal compartment syndrome (ACS). Because of the tense abdomen and hemodynamic instability, urgent bedside abdominal decompression via paracentesis was performed. This led to immediate improvement in airway pressures and blood pressure. Exploratory laparotomy found no visceral perforation or clear source for the free intraperitoneal air.<br /><br />The case highlights spontaneous pneumoperitoneum, a rare condition defined by free air in the abdomen without hollow viscus perforation, trauma, or surgery. Although uncommon, it can cause ACS and multiorgan dysfunction by increasing intra-abdominal pressure and impairing ventilation, venous return, and organ perfusion.<br /><br />The authors emphasize that prompt recognition, emergent decompression, and multidisciplinary coordination between critical care, surgery, and radiology are essential. In clinically deteriorating patients, early operative exploration may be appropriate even when the cause of pneumoperitoneum is unclear. The patient recovered gradually, was extubated on hospital day 8, and discharged on day 12 after stabilization.

Asset Subtitle

Logan Mills

Meta Tag

Author List Logan Mills

Category Clinical Vignettes

Concept Pneumoperitoneum

Concept Abdominal Compartment Syndrome

Concept Abdominal Distension

Concept Organ Dysfunction

Concept Bedside Decompression

Distinguished Non-Finalist

Presenter Organization Memorial Health System of Southwest Oklahoma

Presenting Author Logan Mills

Track Adult

Keywords

spontaneous pneumoperitoneum

abdominal compartment syndrome

pulmonary embolism

hypoxemia

syncope

paracentesis

exploratory laparotomy

intra-abdominal pressure

hemodynamic instability

multiorgan dysfunction

Pneumoperitoneum

Abdominal Compartment Syndrome

Abdominal Distension

Organ Dysfunction

Bedside Decompression