Sato Motoya, Toyoshima Kenji, Tamura Yoshiaki, Araki Atsushi
Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Institute for Geriatrics and Gerontology 35-2 Sakaecho, Itabashi-ku, Tokyo 173-0015, Japan.
The Center for Comprehensive Care and Research for Prefrailty, Tokyo Metropolitan Institute for Geriatrics and Gerontology 35-2 Sakaecho, Itabashi-ku, Tokyo 173-0015, Japan.
Oxf Med Case Reports. 2023 Aug 20;2023(8):omad079. doi: 10.1093/omcr/omad079. eCollection 2023 Aug.
A 41-year-old woman was referred to our emergency department with a 3-day history of upper abdominal pain. We diagnosed her with diabetic ketoacidosis (DKA) after laboratory tests indicated a blood glucose level of 569 mg/dL, positive urine ketone bodies and metabolic acidosis. Plain computed tomography (CT) scan revealed free gas surrounding the porta hepatis and gastric pylorus, which disappeared on the subsequent contrast-enhanced CT scan. Upper gastrointestinal endoscopy demonstrated no perforations; therefore, we assumed that the free gas was caused by spontaneous pneumoperitoneum. The patient had fulminant type 1 diabetes mellitus, as evidenced by her glycated hemoglobin A1c level of 6.9%, reduced insulin secretion and negative islet-specific autoantibodies. Pneumoperitoneum did not recur with conservative treatment, and DKA improved with intravenous fluids and insulin administration. Conservative management of DKA with spontaneous pneumoperitoneum may be considered if the patient's general condition is stable and there are no signs of peritoneal irritation.
一名41岁女性因上腹部疼痛3天被转诊至我院急诊科。实验室检查显示血糖水平为569mg/dL、尿酮体阳性及代谢性酸中毒后，我们诊断她为糖尿病酮症酸中毒（DKA）。平扫计算机断层扫描（CT）显示肝门和胃幽门周围有游离气体，而在随后的增强CT扫描中该气体消失。上消化道内镜检查未发现穿孔；因此，我们认为游离气体是由自发性气腹引起的。该患者为暴发性1型糖尿病，糖化血红蛋白A1c水平为6.9%、胰岛素分泌减少及胰岛特异性自身抗体阴性可证明。经保守治疗气腹未复发，通过静脉补液和胰岛素治疗DKA得到改善。如果患者一般情况稳定且无腹膜刺激征，可考虑对伴有自发性气腹的DKA进行保守治疗。
