c l i n i c a l f o l i o s : n a r r a t i v e





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Pseudopneumoperitoneum: 31

A D V E R T I S E M E N T

   

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The mesoappendix was checked for hemostasis.     

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Pseudopneumoperitoneum: 32

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The abdomen was lavaged with saline. Since no evidence of peritoneal soilage was present, it was elected to terminate the procedure and observe the patient, despite the absence of a source of the free air. The appendix was insufflated with air under water with a catheter in the lumen, and there was no microscopic leak. The patient was asymptomatic the following day with normal temperature and white count. His diet was advanced as tolerated on the second post-op day and he was discharged the following day. One week later when seen in clinic he was asymptomatic.   

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Pseudopneumoperitoneum: 33

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The puzzling lack of findings led to a re-examination of the pre-op assumptions. On review of the films with staff radiologist, the alternative interpretation of the free subdiaphragmatic air became evident. The crescent of air seen under the left hemidiaphragm was actually in the stomach and distorted by the solid stomach contents. The stomach wall apposed to the diaphragm explained the thickness of the diaphragm.      

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This page was last modified on 8/27/2007.