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      A case of spontaneous idiopathic tension pneumoperitoneum successfully managed with bedside pig-tail catheter

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      Journal of Surgical Case Reports
      Oxford University Press

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          Abstract

          We present a 67-year-old gentleman with a high perioperative mortality and morbidity risk who presented with spontaneous idiopathic tension pneumoperitoneum that was successfully managed with bedside pig-tail catheter insertion. Here we also discuss other potential non-surgical aetiologies of pneumoperitoneum.

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          Most cited references11

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          Application of Weibull model for survival of patients with gastric cancer

          Background Researchers in the medical sciences prefer employing Cox model for survival analysis. In some cases, however, parametric methods can provide more accurate estimates. In this study, we used Weibull model to analyze the prognostic factors in patients with gastric cancer and compared with Cox. Methods We retrospectively studied 1715 patients with gastric cancer. Age at diagnosis, gender, family history, past medical history, tumor location, tumor size, eradicative degree of surgery, depth of tumor invasion, combined evisceration, pathologic stage, histologic grade and lymph node status were chosen as potential prognostic factors. Weibull and Cox model were performed with hazard rate and Akaike Information Criterion (AIC) to compare the efficiency of models. Results The results from both Weibull and Cox indicated that patients with the past history of having gastric cancer had the risk of death increased significantly followed by poorly differentiated or moderately differentiated in histologic grade. Eradicative degree of surgery, pathologic stage, depth of tumor invasion and tumor location were also identified as independent prognostic factors found significant. Age was significant only in Weibull model. Conclusion From the results of multivariate analysis, the data strongly supported the Weibull can elicit more precise results as an alternative to Cox based on AIC.
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            Does pneumoperitoneum always require laparotomy? Report of six cases and review of the literature.

            The presence of intraperitoneal free air signals perforation of a hollow viscus in over 90% of the patients. Rarely, however, the presence of pneumoperitoneum may not indicate an intra-abdominal perforation and thus may not require laparotomy. This condition, which poses a dilemma to the surgeon faced with this problem, is termed "nonsurgical", "spontaneous" or "idiopathic" pneumoperitoneum. Six cases of nonsurgical pneumoperitoneum admitted over a 2-year period to our institution are reported, and the etiological mechanisms and the pathophysiology of the appearance of intra-abdominal free gas are reviewed. Two of the six children with nonsurgical pneumoperitoneum underwent exploratory laparotomy when clinical examination suggested an acute abdomen; no intra-abdominal pathology was documented in one of these patients. In the other children, malrotation was found. Four patients, on ventilatory support, were managed conservatively after performing a diagnostic peritoneal lavage and/or contrast studies those were negative. An appreciation of the condition and its likely etiological factors should improve awareness and possibly reduce the imperative to perform emergency laparotomy on an otherwise well patient with an unexplained pneumoperitoneum.
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              Spontaneous pneumoperitoneum and other nonsurgical causes of intraperitoneal free gas.

              Intraperitoneal free gas seen radiologically as air under the diaphragm nearly always indicates a perforated abdominal viscus that requires surgical intervention. Rarely, however, the presence of a pneumoperitoneum may not indicate an intra-abdominal perforation and thus may not require laparotomy. Such a situation is termed spontaneous or nonsurgical pneumoperitoneum. In this review, we explore the aetiological mechanisms and the pathophysiology of the appearance of intra-abdominal free gas. An appreciation of the condition and its likely aetiological factors should improve awareness and possibly reduce the imperative to perform an emergency laparotomy on an otherwise well patient with an unexplained pneumoperitoneum.
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                Author and article information

                Contributors
                Journal
                J Surg Case Rep
                J Surg Case Rep
                jscr
                Journal of Surgical Case Reports
                Oxford University Press
                2042-8812
                November 2021
                29 November 2021
                29 November 2021
                : 2021
                : 11
                : rjab528
                Affiliations
                General Surgery Department , Mackay Base Hospital, Mackay, QLD, Australia
                General Surgery Department , Mackay Base Hospital, Mackay, QLD, Australia
                General Surgery Department , Mackay Base Hospital, Mackay, QLD, Australia
                Author notes
                Correspondence address. General Surgery Department, Mackay Base Hospital, Mackay, QLD 4740, Australia. E-mail: wendy.chang@ 123456uq.net.au
                Author information
                https://orcid.org/0000-0003-4978-374X
                Article
                rjab528
                10.1093/jscr/rjab528
                8634065
                2b016511-8232-4b18-9595-eba4737aee84
                Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author(s) 2021.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 19 October 2021
                : 8 November 2021
                Page count
                Pages: 4
                Categories
                AcademicSubjects/MED00910
                jscrep/040
                Case Report

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