Neumoperitoneo como complicación de la ventilación mecánica, sin evidencia radiológica de neumotórax / Pneumoperitoneum as complication of mechanical ventilation, without radiologic evidence of pneumothorax

Se define el neumoperitoneo como la presencia de aire libre dentro de la cavidad peritoneal, siendo su causa más frecuente y lo primero a descartar, la perforación de víscera hueca que implica un tratamiento quirúrgico. Existen también neumoperitoneos que no están causados por lesiones intraabdominales, como aquellos que aparecen como complicación de la ventilación mecánica, mucho menos frecuentes, y que normalmente coexisten con neumomediastino y/o neumotórax. Su mecanismo fisiopatológico es el paso de aire a través de las comunicaciones anatómicas de la cavidad torácica a la cavidad abdominal. Presentamos un caso, excepcional por su frecuencia, de neumoperitoneo secundario a barotrauma en el que no se evidencia radiológicamente neumomediastino ni neumotórax (AU)

Pneumoperitoneum is defined as the presence of free air (gas) within the peritoneal cavity; its most frequent cause, and the one which must be ruled out first, is viscus perforation implying surgical management. There are however cases of pneumoperitoneum that are not due to intraabdominal lesions, such as those much less frequent ones occurring as a complication of mechanical ventilation, which usually coexist with pneumomediastinum and/or pneumothorax. The pathophysiological mechanism is the passage of air through the anatomic communications from the thoracic cavity to the abdominal one. We report one case, exceptional because of its low frequency, of pneumoperitoneum secondary to barotrauma in which whether pneumomediastinum nor pneumothorax were radiologically demonstrated (AU)

[Abdominal cystic lymphangioma]. / Linfangioma quístico abdominal.

The cystic lymphangioma is a benign slow-growing tumor derived of the lymphatic vessels. It is presented with more frequency in the childhood and the great majority are diagnosed under 5 years of life. The most frequent localization is in head and neck, although they can be developed in any organ or soft tissue. The intraabdominal presentation is not very frequent (2-8%). The clinical presentation is very variable being the most frequent sign the appearance of an effect mass. The diagnosis of suspicion is radiological by means of abdominal ultrasonography and computed tomography. The treatment is surgical. The definitive diagnosis is always histologic. They can recidive. We present two abdominal cases that illustrate this pathology type.