Das P, Mukherjee R, Pathak D, Gangopadhyay A, Halder S, Singh S K
RG Kar Medical College , Kolkata, West Bengal , India.
Ann R Coll Surg Engl. 2016 Nov;98(8):e197-e199. doi: 10.1308/rcsann.2016.0240. Epub 2016 Sep 22.
Tension pneumoperitoneum is a very rare consequence of acute gangrenous appendicitis. We report a case of a 32-year-old woman who presented with abdominal pain, progressively increasing abdominal distension, profound hemodynamic instability and ventilatory compromise. The diagnosis of tension pneumoperitoneum was confirmed by computed tomography, which showed compression of the intra-abdominal viscera and liver (saddlebag sign) by a large volume of intraperitoneal free air. Urgent needle decompression was done as an emergency measure. Exploratory laparotomy, planned due to persistent peritonitis, revealed gangrenous appendicitis with perforation near its base. Appendicectomy with excision of gangrenous portion of caecum was performed. The purpose of the reporting this case is to highlight that the tension pneumoperitoneum can be, very rarely, associated with gangrenous appendicitis and timely diagnosis is very important for the emergency management of this deadly condition.
张力性气腹是急性坏疽性阑尾炎非常罕见的并发症。我们报告一例32岁女性病例，该患者表现为腹痛、进行性腹胀、严重血流动力学不稳定和通气功能受损。计算机断层扫描证实了张力性气腹的诊断，显示大量腹腔游离气体对腹腔内脏器和肝脏造成压迫（马裤征）。作为紧急措施进行了紧急穿刺减压。由于持续性腹膜炎计划进行剖腹探查，发现坏疽性阑尾炎伴阑尾根部穿孔。行阑尾切除术并切除盲肠坏疽部分。报告该病例的目的是强调张力性气腹非常罕见地可与坏疽性阑尾炎相关，及时诊断对于这种致命情况的紧急处理非常重要。
