Koppikar Sahil, Yu David, Ropeleski Mark, Robertson David
Department of Rheumatology, University of Toronto, Toronto, Canada.
Department of Surgery, Queen's University, Kingston, Canada.
Arch Rheumatol. 2018 Jan 15;33(4):478-481. doi: 10.5606/ArchRheumatol.2018.6589. eCollection 2018 Dec.
Connective tissue diseases can be associated with rare gastrointestinal complications such as pneumatosis intestinalis and pneumoperitoneum. In this article, we report a unique case of recurrent pneumatosis intestinalis and spontaneous pneumoperitoneum without evidence of peritonitis in a patient with long-standing mixed connective tissue disease. Computed tomography scan of the abdomen and pelvis revealed pneumatosis of the jejunum and intra-abdominal free air, without evidence of perforation. The patient was managed non-operatively. Prior to discharge, on post-admission day two, imaging revealed resolution of the pneumatosis but persistent large volume pneumoperitoneum. It is important for clinicians to recognize pneumatosis and pneumoperitoneum as a possible benign complication in patients with mixed connective tissue disease and differentiate it from ruptured viscous. The management of benign spontaneous pneumoperitoneum can be supportive, thereby avoiding unnecessary investigations and surgery.
结缔组织病可能与罕见的胃肠道并发症相关，如肠壁囊样积气和气腹。在本文中，我们报告了一例独特的病例，一名患有长期混合性结缔组织病的患者反复出现肠壁囊样积气和自发性气腹，且无腹膜炎证据。腹部和盆腔计算机断层扫描显示空肠积气和腹腔内游离气体，无穿孔迹象。该患者接受了非手术治疗。入院后第二天出院前，影像学检查显示肠壁囊样积气已消退，但气腹仍大量存在。临床医生认识到肠壁囊样积气和气腹是混合性结缔组织病患者可能出现的良性并发症，并将其与内脏破裂相鉴别非常重要。良性自发性气腹的治疗可以是支持性的，从而避免不必要的检查和手术。
