Karaman Abdurrahman, Demirbilek Savaş, Akin Melih, Gürünlüoğlu Kubilay, Irşi Cesim
Department of Pediatric Surgery, Medical School of Inonu University, 44280, Malatya, Turkey.
Pediatr Surg Int. 2005 Oct;21(10):819-24. doi: 10.1007/s00383-005-1489-3. Epub 2005 Oct 21.
The presence of intraperitoneal free air signals perforation of a hollow viscus in over 90% of the patients. Rarely, however, the presence of pneumoperitoneum may not indicate an intra-abdominal perforation and thus may not require laparotomy. This condition, which poses a dilemma to the surgeon faced with this problem, is termed "nonsurgical", "spontaneous" or "idiopathic" pneumoperitoneum. Six cases of nonsurgical pneumoperitoneum admitted over a 2-year period to our institution are reported, and the etiological mechanisms and the pathophysiology of the appearance of intra-abdominal free gas are reviewed. Two of the six children with nonsurgical pneumoperitoneum underwent exploratory laparotomy when clinical examination suggested an acute abdomen; no intra-abdominal pathology was documented in one of these patients. In the other children, malrotation was found. Four patients, on ventilatory support, were managed conservatively after performing a diagnostic peritoneal lavage and/or contrast studies those were negative. An appreciation of the condition and its likely etiological factors should improve awareness and possibly reduce the imperative to perform emergency laparotomy on an otherwise well patient with an unexplained pneumoperitoneum.
腹腔内游离气体信号的出现提示超过90%的患者存在中空脏器穿孔。然而，气腹的存在很少不提示腹腔内穿孔，因此可能不需要剖腹手术。这种情况给面对此问题的外科医生带来了两难困境，被称为“非手术性”、“自发性”或“特发性”气腹。本文报告了我院在两年期间收治的6例非手术性气腹病例，并对腹腔内游离气体出现的病因机制和病理生理学进行了综述。6例非手术性气腹患儿中有2例在临床检查提示急腹症时接受了剖腹探查；其中1例患者未发现腹腔内病变。在其他患儿中，发现了肠旋转不良。4例接受通气支持的患者在进行诊断性腹腔灌洗和/或造影检查均为阴性后采取了保守治疗。认识这种情况及其可能的病因因素应能提高认识，并可能减少对原本情况良好但有不明原因气腹的患者进行急诊剖腹手术的必要性。
