Sidiqi M Masood, Fletcher David, Billah Tasfeen
Kalgoorlie Regional Hospital, Western Australia, Australia.
Int J Surg Case Rep. 2020;76:33-36. doi: 10.1016/j.ijscr.2020.09.149. Epub 2020 Sep 24.
Idiopathic pneumoperitoneum is an extremely rare condition that can easily be misdiagnosed as an acute abdomen. Awareness of this phenomenon can help avoid unnecessary surgical intervention and the potential associated morbidities.
A 76 year old man presented to hospital with dyspnoea and productive cough and was diagnosed with an infective exacerbation of COPD. He subsequently had a CTPA which showed a significant amount of free intraperitoneal gas in the upper abdomen. He was completely asymptomatic from this with no abdominal pain, distension, or significant rise in inflammatory markers. Of note, he had never had previous abdominal surgery or endoscopic procedures. He showed no signs of peritonism and was closely observed with serial abdominal examinations for 24 h. He subsequently tolerated oral intake and was discharged 8 days after admission.
Spontaneous pneumoperitoneum can be due to a variety of intrathoracic, gynaecologic, intra-abdominal and iatrogenic causes. This is a rare case of asymptomatic idiopathic pneumoperitoneum where no clear aetiology or risk factors were found for his free intraperitoneal gas. To the best of our knowledge there have only been two published case reports in the English literature describing idiopathic pneumoperitoneum in a patient that was completely asymptomatic from it.
As a general surgeon it is important to be aware of the non-surgical causes of pneumoperitoneum. Knowledge of this uncommon condition may help reduce the risk of unnecessary laparotomy.
特发性气腹是一种极为罕见的病症，很容易被误诊为急腹症。认识到这种现象有助于避免不必要的手术干预及相关潜在并发症。
一名76岁男性因呼吸困难和咳痰入院，被诊断为慢性阻塞性肺疾病（COPD）急性加重。随后他接受了CT肺动脉造影（CTPA），结果显示上腹部有大量游离腹腔内气体。他对此完全没有症状，没有腹痛、腹胀，炎症指标也没有显著升高。值得注意的是，他既往从未接受过腹部手术或内镜检查。他没有腹膜炎体征，通过连续24小时的腹部检查进行密切观察。随后他能够耐受经口进食，并在入院8天后出院。
自发性气腹可能由多种胸内、妇科、腹腔内及医源性原因引起。这是一例罕见的无症状特发性气腹病例，其腹腔内游离气体未发现明确病因或危险因素。据我们所知，英文文献中仅有两篇已发表的病例报告描述了完全无症状的特发性气腹患者。
作为一名普通外科医生，了解气腹的非手术原因很重要。了解这种罕见病症可能有助于降低不必要剖腹手术的风险。
