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The following is a summary of “Emergency physician ultrasound diagnosis of pneumoperitoneum in intraoperative patients with peritoneal insufflation,” published in the April 2025 issue of American Journal of Emergency Medicine by Sanghvi et al. 

Researchers conducted a retrospective study to determine the accuracy of emergency physicians (EPs) in diagnosing pneumoperitoneum with POCUS and whether the volume of pneumoperitoneum affected accuracy.  

They obtained point-of-care ultrasound (POCUS) clips from individuals undergoing intraperitoneal insufflation for an elective laparoscopic procedure. Video clips captured the right upper quadrant and epigastric regions before insufflation and after administering 500 ml, 1000 ml, and 1500 ml of insufflation. These clips were randomized and assessed by 3 blinded ultrasound-trained EPs. For each clip, they determined the presence or absence of pneumoperitoneum.  

The results showed that EPs identified pneumoperitoneum in 71% of cases. Sensitivity and specificity were 66% and 85%, respectively. Sensitivity varied by air volume, with 53% for small, 70% for medium, and 73% for large volumes. The AUC for pneumoperitoneum detection was 0.753, while AUC values for small, medium, and large air volumes were 0.688, 0.773, and 0.789, respectively. Substantial agreement was observed among EPs, with a kappa coefficient of 0.658.  

Investigators concluded that POCUS demonstrated moderate sensitivity, high specificity, and moderate accuracy for detecting pneumoperitoneum, with sensitivity improving with larger air volumes, suggesting comparable sensitivity to chest X-ray (CXR). 

Source: sciencedirect.com/science/article/abs/pii/S0735675725000245