Spontaneous Pneumothorax Complicating Artificial Pneumoperitoneum

The spontaneous development of a pneumo-thorax during the course of treatment with an artificial pneumoperitoneum has only rarely been reported. In most instances the pneumothorax has been ascribed to air entering the mediastinum from the abdominal cavity by one of the dia-phragmatic hiatuses, and thence rupturing into the pleural sac, in nearly every case on the right side. A pneumothorax may be induced acciden-tally on either side when the lower intercostal route is employed for the induction or mainten-ance of a pneumoperitoneum, and such accidents are not uncommon (Banyai, 1946); for this reason the intercostal route has largely been abandoned. Banyai, a pioneer of pneumoperitoneum treat-ment, in his experience dating from 1931 has recorded only one case of spontaneous as distinct from accidental pneumothorax (Banyai and Jur-gens, 1940; Banyai, 1946). A man of 53, with a pneumoperitoneum which had been maintained for a year, was given his usual refill of 1,000 ml. through a point well below and to the left of the umbilicus, the final pressures being 12 + 10. Shortly afterwards he suddenly develop-d a right-sided pneumothorax and his pneumoperitoneum rapidly deflated. Mitchell and others (1947) do not mention this complication in their review of 710 cases of artificial pneumoperitoneum, nor does any reference to it occur in the writings