Institute of Clinical Radiology, University Hospital Muenster, Muenster, Germany.
Institute of Clinical Radiology, University Hospital Muenster, Muenster, Germany.
J Vasc Interv Radiol. 2021 Feb;32(2):271-276. doi: 10.1016/j.jvir.2020.09.018. Epub 2020 Oct 28.
To evaluate the feasibility and effectiveness of computed tomography (CT)-guided percutaneous drainage (PD) in patients with iatrogenic pneumoperitoneum presenting as acute abdomen.
In this retrospective, single-center cohort study, 16 consecutive patients (9 males, 7 females; median age, 67.5 [51-85] years) undergoing PD for managing acute abdomen caused by iatrogenic pneumoperitoneum between 2013 and 2019 were analyzed. Inclusion criteria were clinical signs of acute abdomen that was unresponsive to conservative management and pneumoperitoneum due to an iatrogenic cause after PD, observed using CT imaging. Volumetry of pneumoperitoneum was performed using computer-aided image segmentation. To evaluate the clinical outcome, the paired t-test was performed to analyze the course of pain intensity on the numerical pain rating scale (NPRS, 0-10). Patient records were reviewed to determine PD-related adverse events and median drain duration.
The median pneumoperitoneum volume was 891.1 (127.7-3,677.0) mL. All PD procedures were successfully performed, with symptom relief and immediate abdominal decompression (mean segmental volume reduction, 79.8% ± 13.5). Acute abdomen symptoms were resolved, with significant improvement in pain intensity between the day of the PD procedure and the first day after the procdure (mean NPRS scores, 3.3 ± 1.9 vs 0.8 ± 1.0; P < .001). The median drain duration was 2 (1-3) days. No PD-associated adverse events were observed. After PD, 14 patients required only conservative management, whereas 2 patients with anastomotic leakage required additional surgery as they showed signs of persisting sepsis and generalized peritonitis.
PD is a safe and suitable procedure for the management of symptoms in patients with iatrogenic pneumoperitoneum presenting as acute abdomen.
评估 CT 引导下经皮引流（PD）治疗医源性气腹引起的急性腹痛的可行性和有效性。
本回顾性、单中心队列研究纳入了 2013 年至 2019 年期间因 PD 后医源性气腹引起的急性腹痛而行 PD 治疗的 16 例连续患者（9 名男性，7 名女性；中位年龄 67.5 [51-85] 岁）。纳入标准为 PD 后出现经 CT 影像学证实的临床症状性气腹且对保守治疗无反应。采用计算机辅助图像分割法对气腹量进行容积测量。采用配对 t 检验分析数字疼痛评分量表（NPRS，0-10）上疼痛强度的变化，以评估临床结局。回顾患者记录以确定与 PD 相关的不良事件和中位引流时间。
中位气腹量为 891.1（127.7-3677.0）mL。所有 PD 操作均成功完成，症状缓解且即刻腹部减压（平均节段性体积减少率为 79.8%±13.5%）。急性腹痛症状得到缓解，PD 术后第一天与术后第一天相比疼痛强度显著改善（NPRS 评分均值分别为 3.3±1.9 与 0.8±1.0；P<.001）。中位引流时间为 2（1-3）天。未观察到与 PD 相关的不良事件。PD 后，14 例患者仅接受保守治疗，而 2 例吻合口漏患者因持续感染和弥漫性腹膜炎迹象需要进一步手术治疗。
PD 是治疗医源性气腹引起的急性腹痛症状的一种安全且合适的方法。
