Johnson Christopher L, Gomes Camilla, Cheng Justin, Lebares Carter C
School of Medicine, University of California San Francisco, San Francisco, CA 94143, USA.
Department of Surgery, University of California San Francisco, San Francisco, CA 94143, USA.
J Surg Case Rep. 2022 May 18;2022(5):rjac219. doi: 10.1093/jscr/rjac219. eCollection 2022 May.
Spontaneous pneumoperitoneum in a patient with a tracheostomy tube following cardiopulmonary resuscitation is exceedingly rare, with little experimental nor observational data to guide evidence-based management. We present the case of a 75-year-old woman with a tracheostomy tube who developed pneumoperitoneum following CPR. The patient experienced pulseless electrical activity arrest requiring nine rounds of chest compressions to return to spontaneous circulation. Computerized tomography demonstrated pneumothoraces, subcutaneous emphysema and extensive intraperitoneal, extraperitoneal and retroperitoneal free air without evidence of visceral perforation. The patient's abdomen was distended without tenderness, guarding or rebound. She had a white blood cell count mildly elevated from her baseline levels. The management plan of serial abdominal exams without operative intervention was chosen given the absence of clinical and laboratory signs of peritonitis. This case highlights the importance of developing a standardized management algorithm for patients with pneumoperitoneum in the setting of tracheostomy tubes without evidence of perforation.
心肺复苏后气管切开患者出现自发性气腹极为罕见，几乎没有实验数据或观察数据可用于指导循证管理。我们报告一例75岁气管切开女性患者在心肺复苏后发生气腹的病例。该患者出现无脉电活动骤停，需要进行九轮胸外按压才能恢复自主循环。计算机断层扫描显示气胸、皮下气肿以及广泛的腹腔内、腹膜外和腹膜后游离气体，未发现内脏穿孔迹象。患者腹部膨隆，无压痛、肌紧张或反跳痛。她的白细胞计数较基线水平轻度升高。鉴于没有腹膜炎的临床和实验室体征，选择了进行系列腹部检查而不进行手术干预的管理方案。本病例强调了为无穿孔证据的气管切开管患者气腹制定标准化管理算法的重要性。
