Lipson D A, Tino G, Vaughn D
Department of Medicine, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
Chest. 1999 Sep;116(3):827-30. doi: 10.1378/chest.116.3.827.
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.
气腹的鉴别诊断范围很广。我们报告一例机械通气患者发生张力性气腹的病例，该患者最初未被识别出气胸且留置了胸膜 - 腹膜分流管。当气体从胸膜腔转移至腹腔时，患者出现通气和血流动力学衰竭。随后的腹部探查揭示了腹腔内气体的来源。放置胸腔闭式引流管并拔除胸膜 - 腹膜导管后，患者临床症状显著改善。我们认为，认识到胸膜 - 腹膜导管可能在无明显并发气胸的情况下导致张力性气腹很重要。
