Sakaguchi Tatsuma, Kotsuka Masaya, Yamamichi Keigo, Sekimoto Mitsugu
Department of Gastrointestinal Surgery, Medical Center, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi-city, Osaka 570-8507, Japan.
Department of Gastrointestinal Surgery, Medical Center, Kansai Medical University, 10-15 Fumizono-cho, Moriguchi-city, Osaka 570-8507, Japan.
Int J Surg Case Rep. 2021 Oct;87:106463. doi: 10.1016/j.ijscr.2021.106463. Epub 2021 Oct 1.
Pneumoperitoneum usually requires emergency surgery. Asymptomatic idiopathic pneumoperitoneum is a rare subgroup of pneumoperitoneum for which a management algorithm has not been established.
In an 88-year-old female patient, pneumoperitoneum was found incidentally by chest computed tomography during a periodic follow-up for sarcoidosis. Emergency admission was ordered for conservative treatment. Upper gastrointestinal endoscopy revealed edematous mucosa in the entire gastric vestibule. After being discharged on the 7th day, her clinical course was uneventful over 2 months of follow-up.
The initial clinical manifestations of pneumoperitoneum are variable and range widely from asymptomatic to septic shock. The etiology of pneumoperitoneum in our patient implied a subclinical visceral perforation that resolved without treatment. We advocate an algorithm for the initial management of pneumoperitoneum according to the extent of peritonitis and impaired conditions.
Incidentally found asymptomatic pneumoperitoneum does not always require intervention. Careful and repeated physical assessment with investigation of underlying etiology is important in the management of pneumoperitoneum.
气腹通常需要紧急手术。无症状特发性气腹是气腹的一个罕见亚组，尚未建立其治疗方案。
在一名88岁女性患者中，在结节病定期随访期间，胸部计算机断层扫描偶然发现气腹。因保守治疗而紧急入院。上消化道内镜检查显示整个胃前庭黏膜水肿。在第7天出院后，随访2个月期间其临床过程平稳。
气腹的初始临床表现各不相同，范围从无症状到感染性休克。我们患者气腹的病因提示为亚临床内脏穿孔，未经治疗而自行缓解。我们提倡根据腹膜炎程度和身体状况对气腹进行初始治疗的方案。
偶然发现的无症状气腹并不总是需要干预。在气腹的治疗中，仔细且反复的体格检查以及对潜在病因的调查很重要。
