Conservative management of idiopathic pneumoperitoneum masquerading as peritonitis: report of a case.

Pneumoperitoneum is most commonly caused by the perforation of a hollow viscus, in which case an emergency laparotomy is indicated. We report herein the case of a patient who presented with the signs and symptoms of peritonitis, but who was found to have idiopathic pneumoperitoneum which was successfully managed by conservative treatment. A 70-year-old man presented with epigastric pain, nausea, and a severely distended and tympanitic abdomen. Abdominal examination revealed diffuse tenderness with guarding, but no rebound tenderness. He was febrile with leukocytosis and high C-reactive protein. Chest X-ray and abdominal computed tomography demonstrated a massive pneumoperitoneum without pneumothorax, pneumomediastinum, pneumoretroperitoneum, or subcutaneous emphysema, and subsequent examinations failed to demonstrate perforation of a hollow viscus. Thus, a diagnosis of idiopathic pneumoperitoneum was made, and the patient was managed conservatively, which resulted in a successful outcome. This experience and a review of the literature suggest that idiopathic pneumoperitoneum is amenable to conservative management, even when the signs and symptoms of peritonitis are present.

[The effects of selective proximal gastric vagotomy on antral mucosal gastrin and somatostatin concentrations].

Antral mucosal immunoreactive gastrin (IRG) and somatostatin-like immunoreactivity (SLI) were measured in separate prepyloric mucosal canine specimens obtained before and after selective proximal vagotomy (SPV). No significant difference was recognized in the distribution of IRG concentration in the mucosa of the anterior and posterior walls and in the mucosa of the lesser and greater curvatures. The IRG concentration in the mucosa had no correlation to the distance from the pyloric ring. The IRG concentration of specimens obtained within about 3 cm from the pyloric ring could be regarded as that of the antral mucosa. The effects of surgery on antral mucosal IRG and SLI were studied in 13 dogs consisted of two groups: SPV and simple laparotomy. No significant postoperative change of IRG or SLI concentrations was noted in simple laparotomy group. In SPV group, however, the IRG concentration rose significantly in the 8th and 12th weeks postoperatively (p less than 0.01). There was no significant change in the SLI concentration in the SPV group, but two of the seven dogs showed the high elevations after the 12th week. These results suggested that SPV has a more marked effect on the production of antral gastrin than that of antral somatostatin.