腹腔镜子宫切除术后48天出现气腹。
Pneumoperitoneum 48 days after laparoscopic hysterectomy.
作者信息
Smith Kevin S, Wilson Tiffany C, Luces LaToya, Stevenson Adrienne A, Hajhosseini Babak, Siram Suryanarayana M
机构信息
Howard University Hospital, Department of Obstetrics & Gynecology, 2041 Georgia Ave NW, WA, DC 20060, USA.
Howard University Hospital, Department of Obstetrics and Gynecology, WA DC, USA.
出版信息
JSLS. 2013 Oct-Dec;17(4):661-4. doi: 10.4293/108680813X13794522666446.
BACKGROUND AND OBJECTIVES
Postoperative pneumoperitoneum following laparoscopic surgery is self-limited, typically resolving within days.
METHODS
We analyzed the case of a 48-y-old woman who presented with acute abdominal pain 48 d after a total laparoscopic hysterectomy. Imaging studies revealed free air under the diaphragm suggesting a perforated viscus.
RESULTS
An exploratory laparotomy was performed, but no perforations or organic traumas were found intraoperatively. To the best of our knowledge, this is the longest period of time reported for persistent pneumoperitoneum after laparoscopic surgery.
CONCLUSION
Absent clinical findings, introduction of atmospheric air into the abdominal cavity during the original laparoscopic surgery was the most likely cause and is supported by the literature. Pneumoperitoneum observed up to 48 d status post laparoscopic hysterectomy, in the absence of peritoneal signs, fever, leukocytosis, or hemodynamic instability, may be considered for expectant management and serial inspection for clinical change.
背景与目的
腹腔镜手术后的气腹是自限性的，通常在数天内消退。
方法
我们分析了一例48岁女性患者的病例，该患者在全腹腔镜子宫切除术后48天出现急性腹痛。影像学检查显示膈下有游离气体，提示存在脏器穿孔。
结果
进行了剖腹探查，但术中未发现穿孔或器质性损伤。据我们所知，这是腹腔镜手术后持续性气腹报道的最长时间。
结论
在无临床发现的情况下，最初腹腔镜手术期间腹腔内进入空气是最可能的原因，且有文献支持。在腹腔镜子宫切除术后长达48天观察到气腹，在无腹膜体征、发热、白细胞增多或血流动力学不稳定的情况下，可考虑进行观察处理并连续检查临床变化。
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