Case Report
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World J Gastrointest Surg. Dec 27, 2013; 5(12): 329-331
Published online Dec 27, 2013. doi: 10.4240/wjgs.v5.i12.329
Uncommon cause of pneumoperitoneum
Laura van Nunspeet, Eric Hans Eddes, Mirre E de Noo
Laura van Nunspeet, Eric Hans Eddes, Mirre E de Noo, Department of Surgery, Deventer Ziekenhuis, 7416 SE Deventer, The Netherlands
Author contributions: van Nunspeet L drafted of the manuscript; Eddes EH and de Noo ME critically revised the manuscript.
Correspondence to: Laura van Nunspeet, MSc, Department of Surgery, Deventer Ziekenhuis, Nico Bolkesteinlaan 75, 7416 SE Deventer, The Netherlands. lvannunspeet@gmail.com
Telephone: +31-570-535060 Fax: +31-570-501419
Received: October 15, 2013
Revised: November 25, 2013
Accepted: December 12, 2013
Published online: December 27, 2013
Processing time: 71 Days and 12.8 Hours
Abstract

Free intraperitoneal air is thought to be pathognomonic for perforation of a hollow viscus. Here, we present a patient with pain in the upper left quadrant, a mild fever and leukocytosis. Free air was suggested under the left diaphragm but during the explorative laparotomy no signs of gastric or diverticular perforation were seen. Further exploration and revision of the computed tomography revealed a perforated splenic abscess. Splenic abscesses are a rare clinical entity. Presenting symptoms are often non-specific and include upper abdominal pain, recurrent or persistent fever, nausea and vomiting, splenomegaly, leukocytosis and left lower chest abnormalities. Predisposing conditions can be very divergent and include depressed immunosuppressed state, metastatic or contiguous infection, splenic infarction and trauma. Splenic abscess should therefore be considered in a patient with fever, left upper abdominal pain and leukocytosis. Moreover, our case shows that splenic abscess can present in an exceptional way without clear underlying aetiology and should even be considered in the presence of free abdominal air.

Keywords: Spleen, Abscess, Pneumoperitoneum

Core tip: Free intraperitoneal air is thought to be pathognomonic for perforation of a hollow viscus. Here, we present a patient with pain in the upper left quadrant, a mild fever and leukocytosis. Free air was suggested under the left diaphragm but during the explorative laparotomy no signs of gastric or diverticular perforation were seen. Further exploration and revision of the computed tomography revealed a perforated splenic abscess. Splenic abscesses are a rare clinical entity. Our case shows that splenic abscess can present in an exceptional way without clear underlying aetiology and should even be considered in the presence of free abdominal air.