García-Santos Esther, Puerto-Puerto Alejandro, Sánchez-García Susana, Ruescas-García Francisco Javier, Alberca-Páramo Ana, Martín-Fernández Jesús
Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
Servicio de Urología, Hospital San Pedro de Alcántara, Cáceres, España.
Cir Cir. 2015 Sep-Oct;83(5):429-32. doi: 10.1016/j.circir.2015.05.046. Epub 2015 Jul 6.
Pneumoperitoneum is defined as the existence of extraluminal air in the abdominal cavity. In 80-90% of cases is due to perforation of a hollow organ. However, in 10-15% of cases, it is nonsurgical pneumoperitoneum.
The case of a patient undergoing mechanical ventilation, developing abdominal compartment syndrome tension pneumoperitoneum is reported.
Female, 75 years old asking for advise due to flu of long term duration. Given her respiratory instability, admission to the Intensive Care Unit is decided. It is then intubated and mechanically ventilated. Chest x-ray revealed a large pneumoperitoneum but no pneumothorax neither mediastinum; and due to the suspicion of viscera perforation with clinical instability secondary to intra-abdominal hypertension box, emergency surgery was decided.
When discarded medical history as a cause of pneumoperitoneum, it is considered that ventilation is the most common cause. Benign idiopathic or nonsurgical pneumoperitoneum, can be be treated conservatively if the patient agrees. But if intraabdominal hypertension prevails, it can result in severe respiratory and hemodynamic deterioration, sometimes requiring abdominal decompression to immediately get lower abdominal pressure and thus improve hemodynamic function.
气腹被定义为腹腔内存在腔外气体。80% - 90%的病例是由于中空器官穿孔所致。然而，10% - 15%的病例为非手术性气腹。
报告一例接受机械通气的患者发生腹腔间隔室综合征张力性气腹的病例。
一名75岁女性因长期流感前来咨询。鉴于其呼吸不稳定，决定收入重症监护病房。随后对其进行插管并机械通气。胸部X光显示大量气腹，但无气胸及纵隔气肿；由于怀疑存在内脏穿孔且伴有腹腔内高压导致的临床不稳定，决定进行急诊手术。
当排除病史作为气腹原因时，认为通气是最常见的原因。良性特发性或非手术性气腹，如果患者同意，可进行保守治疗。但如果腹腔内高压持续存在，可能导致严重的呼吸和血流动力学恶化，有时需要进行腹腔减压以立即降低腹内压，从而改善血流动力学功能。
