Gutkin Z, Iellin A, Meged S, Sorkine P, Geller E
Department of Surgery C, Ichilov Hospital, Tel-Aviv, Israel.
Int Surg. 1992 Jul-Sep;77(3):219-23.
Spontaneous pneumoperitoneum without peritonitis is a rare phenomenon which poses a dilemma to the surgeon faced with this problem. Two such cases and their outcome are presented. The first case was caused by barotrauma during positive pressure ventilation and was treated by laparotomy. No perforated viscus was found. The second case was caused by tracheal rupture during emergency intubation and was treated by observation until complete resolution. Both patients died for reasons unrelated to the pneumoperitoneum. The mechanisms for passage of air from the chest into the abdominal cavity were through the diaphragm in the first case and along the great vessels in the second. A compilation of other etiologies of pneumoperitoneum without peritonitis as extracted from the literature is presented. In the presence of pneumoperitoneum without peritonitis and when the clinical history does not suggest perforation of a viscus, we advise performing an abdominal tap. If negative, continued observation is advised.
无腹膜炎的自发性气腹是一种罕见现象，给面对此问题的外科医生带来了两难境地。本文介绍了两例此类病例及其结果。第一例由正压通气期间的气压伤引起，通过剖腹手术治疗。未发现内脏穿孔。第二例由紧急插管期间的气管破裂引起，通过观察直至完全缓解进行治疗。两名患者均因与气腹无关的原因死亡。第一例中空气从胸部进入腹腔的机制是通过膈肌，第二例是沿着大血管。本文还汇总了从文献中提取的无腹膜炎气腹的其他病因。在存在无腹膜炎的气腹且临床病史未提示内脏穿孔时，我们建议进行腹腔穿刺。如果穿刺结果为阴性，建议继续观察。
