Summers B
Br Med J. 1979 Jun 9;1(6177):1528-30. doi: 10.1136/bmj.1.6177.1528.
Four adults injured in serious road-traffic accidents developed pneumoperitoneum after artificial ventilation. No case could be attributed to injury or to perforation of a hollow viscus in the belly, but doubt about this in one patient resulted in exploratory laparotomy. In three patients the origin of intraperitoneal air was considered to be leakage through minute ruptures in alveoli subjected to the stress of artificial ventilation, with air tracking to the mediastinum, pleural space, subcutaneous tissues of the neck and chest, and peritoneal cavity. The fourth patient later developed herniation of the stomach through a rupture in the diaphragm, the presence of a pneumothorax on the same side suggesting direct passage of air through the diaphragm. Pneumoperitoneum induced by artificial ventilation is probably more common than reports suggest and should be distinguished clinically and radiologically from that caused by rupture or perforation of a hollow viscus. This will reduce the number of needles laparotomies performed on patients who are already seriously ill.
4名在严重道路交通事故中受伤的成年人在人工通气后出现气腹。没有一例可归因于腹部损伤或中空脏器穿孔，但对其中一名患者的怀疑导致了剖腹探查术。在3名患者中，腹腔内气体的来源被认为是肺泡在人工通气压力下出现微小破裂后气体泄漏，气体沿着通道进入纵隔、胸腔、颈部和胸部的皮下组织以及腹腔。第四名患者后来出现胃通过膈肌破裂处疝出，同侧气胸的存在提示气体直接通过膈肌。人工通气诱发的气腹可能比报道的更为常见，应在临床和影像学上与中空脏器破裂或穿孔所致气腹相鉴别。这将减少对已患有重病患者进行的剖腹探查术的次数。
