Division of Rheumatology, University of Connecticut Health Center, Farmington, CT, USA.
J Clin Rheumatol. 2010 Dec;16(8):379-81. doi: 10.1097/RHU.0b013e3181ffeb49.
The gastrointestinal tract is commonly involved in patients with systemic sclerosis (SSc) (Am J Gastroenterol. 1972;58:30-44). Intestinal manifestations of SSc include impaired motility, malabsorption, bacterial overgrowth, jejunal and wide-mouthed colonic diverticuli, localized dilatation, pseudo-obstruction, and, less commonly, pneumatosis cystoides intestinalis (PCI) (Rheumatology. 2009;48:iii36-iii39; J Clin Gastroenterol. 2008;42:5-12). Benign spontaneous pneumoperitoneum is a rare complication of SSc and is often associated with PCI (Mo Med. 1967;64:117-118). We report a case of spontaneous pneumoperitoneum without evidence of peritoneal irritation in a malnourished patient with long-standing SSc. Computed tomography scan of the abdomen and pelvis on admission revealed pneumoperitoneum with PCI without visceral perforation. Subsequent imaging revealed the persistence of the pneumoperitoneum with resolution of the PCI. It is important for the clinician to recognize benign spontaneous pneumoperitoneum as a possible complication in patients with SSc and to be able to differentiate this from a ruptured viscus with peritonitis based on clinical presentation. The management of benign spontaneous pneumoperitoneum is supportive, thereby avoiding unnecessary surgery.
胃肠道在系统性硬化症（SSc）患者中常受累（Am J Gastroenterol. 1972;58:30-44）。SSc 的肠道表现包括运动功能障碍、吸收不良、细菌过度生长、空肠和宽口结肠憩室、局部扩张、假性肠梗阻，以及较少见的肠囊样积气（PCI）（Rheumatology. 2009;48:iii36-iii39; J Clin Gastroenterol. 2008;42:5-12）。良性自发性气腹是 SSc 的罕见并发症，常与 PCI 相关（Mo Med. 1967;64:117-118）。我们报告了一例长期 SSc 营养不良患者出现无腹膜刺激征的自发性气腹。入院时的腹部和骨盆 CT 扫描显示有 PCI 的气腹，但无内脏穿孔。随后的影像学检查显示气腹持续存在，PCI 消失。临床医生识别出 SSc 患者可能出现良性自发性气腹，并能够根据临床表现将其与腹膜炎导致的破裂内脏区分开来非常重要。良性自发性气腹的治疗是支持性的，从而避免了不必要的手术。
