van Gelder H M, Allen K B, Renz B, Sherman R
Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
Am Surg. 1991 Mar;57(3):151-6.
Pneumoperitoneum is usually the result of hollow viscus perforation with associated peritonitis. Nonsurgical spontaneous pneumoperitoneum incidental to intrathoracic, intra-abdominal, gynecologic, iatrogenic, and other miscellaneous causes not associated with perforated viscus have been documented in the literature. Seven cases of spontaneous pneumoperitoneum admitted over 3-year period to Grady Memorial Hospital, Atlanta, Georgia are reported. Six patients with pneumoperitoneum underwent exploratory laparotomy when clinical examination suggested an acute abdomen; no intra-abdominal pathology was documented in any of these patients. A seventh patient, on ventilatory support, was managed conservatively after performing a diagnostic peritoneal lavage that was negative. There were no cases of radiographically misdiagnosed pneumoperitoneum. Pneumoperitoneum, preceded by a reasonable incidental cause in a patient with a adequate abdominal examination, may warrant continued observation thus avoiding an unnecessary laparotomy.
气腹通常是中空脏器穿孔并伴有腹膜炎的结果。文献中已记载了非手术性自发性气腹，其继发于胸腔、腹腔、妇科、医源性及其他与穿孔脏器无关的各种原因。本文报告了佐治亚州亚特兰大市格雷迪纪念医院在3年期间收治的7例自发性气腹病例。6例气腹患者在临床检查提示急腹症时接受了剖腹探查；这些患者均未发现腹腔内病变。第7例患者在接受通气支持，经诊断性腹腔灌洗为阴性后，采取了保守治疗。没有影像学误诊气腹的病例。对于腹部检查正常、有合理偶然原因导致的气腹患者，可考虑继续观察，从而避免不必要的剖腹探查。
