Kane N M, Francis I R, Burney R E, Wheatley M J, Ellis J H, Korobkin M
Department of Radiology, University of Michigan Hospitals, Ann Arbor 48109-0326.
Invest Radiol. 1991 Jun;26(6):574-8.
Pneumoperitoneum detected on plain radiographs following blunt abdominal trauma is nearly pathognomonic of bowel perforation and usually mandates exploratory laparotomy. To determine the significance of computed tomography (CT)-detected pneumoperitoneum, we reviewed the clinical records and imaging studies of all trauma patients in our hospital over a seven-year period whose abdominal CT scans showed free intraperitoneal gas. Patients who had penetrating injuries or peritoneal lavage prior to CT were excluded. Of the 18 patients who met these inclusion criteria, surgically confirmed bowel injury was found in only four (22%). In the remaining 14 patients, no evidence of gastrointestinal perforation was found by exploratory laparotomy (2 patients), diagnostic peritoneal lavage (4 patients), GI studies and clinical follow-up (6 patients), or clinical follow-up alone (5 patients). Seven patients had a pneumothorax as a possible cause for pneumoperitoneum. Two additional patients were on mechanical ventilation. Unlike pneumoperitoneum seen on plain film, CT-detected pneumoperitoneum is not pathognomonic of bowel perforation. While laparotomy is not mandatory in the non-surgically explored patient, close clinical observation is essential, and additional diagnostic tests such as peritoneal lavage or radiographic contrast studies can be beneficial to confirm the absence of intestinal injury.
钝性腹部创伤后X线平片上发现的气腹几乎是肠穿孔的特征性表现，通常需要进行剖腹探查术。为了确定计算机断层扫描（CT）检测到的气腹的意义，我们回顾了我院7年间所有腹部CT扫描显示腹腔内有游离气体的创伤患者的临床记录和影像学研究。排除在CT检查前有穿透伤或进行过腹腔灌洗的患者。在符合这些纳入标准的18例患者中，仅4例（22%）经手术证实有肠损伤。在其余14例患者中，经剖腹探查术（2例）、诊断性腹腔灌洗（4例）、胃肠道检查及临床随访（6例）或仅临床随访（5例）均未发现胃肠道穿孔的证据。7例患者气胸可能是气腹的原因。另外2例患者正在接受机械通气。与X线平片上所见的气腹不同，CT检测到的气腹并非肠穿孔的特征性表现。对于未进行手术探查的患者，虽然剖腹手术并非必需，但密切的临床观察至关重要，额外的诊断检查如腹腔灌洗或造影检查有助于证实没有肠道损伤。
