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Tension Pneumoperitoneum Associated With a Pleural-Peritoneal Shunt*

David A. Lipson, MD; Gregory Tino, MD; David Vaughn, MD
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* From the Department of Medicine, Pulmonary and Critical Care Division (Drs. Lipson and Tino), and the Division of Hematology and Oncology (Dr. Vaughn), University of Pennsylvania Medical Center, Philadelphia, PA.

Correspondence to: Gregory Tino, MD, Hospital of the University of Pennsylvania, 3600 Spruce St, 831 West Gates Building, Philadelphia, PA 19104; e-mail: gregtino@mail.med.upenn.edu



Chest. 1999;116(3):827-830. doi:10.1378/chest.116.3.827
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The differential diagnosis of pneumoperitoneum is broad. We report a case of tension pneumoperitoneum in a patient on mechanical ventilation with initially unrecognized pneumothorax who had an indwelling pleural-peritoneal shunt. The patient developed ventilatory and hemodynamic collapse as air was diverted from the pleural space into the peritoneal cavity. Subsequent abdominal exploration revealed the source of the intra-abdominal air. Placement of a chest thoracostomy tube and removal of the pleural-peritoneal catheter resulted in significant clinical improvement. We suggest that it is important to recognize that pleural-peritoneal catheters may cause tension pneumoperitoneum without obvious concurrent pneumothorax.

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