Raabe Gitte Grunnet, Schelde-Olesen Benedicte, Bjørsum-Meyer Thomas
Department of Surgery, Odense University Hospital and Svendborg Hospital, Odense and Svendborg, Denmark.
J Surg Case Rep. 2022 Mar 17;2022(3):rjac072. doi: 10.1093/jscr/rjac072. eCollection 2022 Mar.
A 46-year-old male referred to the Emergency Department with pain in the left flank. The patient suffered from Crohn's disease. He had not experienced any fever, and a urine strip showed signs of blood. A ureteric calculus was suspected and a computed tomography scan was performed, which surprisingly showed free intraperitoneal air (FIA) located along the ascending colon. The patient had no signs indicative of peritonitis and the spontaneous pneumoperitoneum was suspected. Pneumoperitoneum is often associated with severe intraabdominal pathology, such as perforation of the gastrointestinal tract, requiring acute surgical intervention. In ~10% of all cases of FIA, the cause is related to conditions not requiring prompt surgical intervention. Doctors need to recognize the rare condition of spontaneous pneumoperitoneum and correlate these findings to patient complaints to be able to choose the correct conservative strategy and to avoid unnecessary surgical procedures and risks for the patient.
一名46岁男性因左侧腰部疼痛被送往急诊科。该患者患有克罗恩病。他没有发烧，尿试纸显示有血尿迹象。怀疑有输尿管结石，遂进行了计算机断层扫描，结果令人惊讶地显示沿升结肠有游离腹腔内气体（FIA）。患者没有腹膜炎的体征，怀疑是自发性气腹。气腹通常与严重的腹腔内病变有关，如胃肠道穿孔，需要进行紧急手术干预。在所有FIA病例中，约10%的病因与不需要立即手术干预的情况有关。医生需要认识到自发性气腹这种罕见情况，并将这些发现与患者的症状相关联，以便能够选择正确的保守策略，避免给患者带来不必要的手术和风险。
