Tani T, Shirai Y, Sasagawa M, Wanifuchi T, Yagi K, Satoh I, Hatakeyama K
Department of Surgery, Niigata University School of Medicine, Japan.
Surg Today. 1995;25(3):265-7. doi: 10.1007/BF00311539.
Pneumoperitoneum is most commonly caused by the perforation of a hollow viscus, in which case an emergency laparotomy is indicated. We report herein the case of a patient who presented with the signs and symptoms of peritonitis, but who was found to have idiopathic pneumoperitoneum which was successfully managed by conservative treatment. A 70-year-old man presented with epigastric pain, nausea, and a severely distended and tympanitic abdomen. Abdominal examination revealed diffuse tenderness with guarding, but no rebound tenderness. He was febrile with leukocytosis and high C-reactive protein. Chest X-ray and abdominal computed tomography demonstrated a massive pneumoperitoneum without pneumothorax, pneumomediastinum, pneumoretroperitoneum, or subcutaneous emphysema, and subsequent examinations failed to demonstrate perforation of a hollow viscus. Thus, a diagnosis of idiopathic pneumoperitoneum was made, and the patient was managed conservatively, which resulted in a successful outcome. This experience and a review of the literature suggest that idiopathic pneumoperitoneum is amenable to conservative management, even when the signs and symptoms of peritonitis are present.
气腹最常见的原因是中空脏器穿孔，在这种情况下需要进行急诊剖腹手术。我们在此报告一例患者，该患者表现出腹膜炎的体征和症状，但被发现患有特发性气腹，通过保守治疗成功治愈。一名70岁男性患者出现上腹部疼痛、恶心以及腹部严重膨隆和鼓音。腹部检查发现弥漫性压痛伴肌紧张，但无反跳痛。他发热，白细胞增多，C反应蛋白升高。胸部X线和腹部计算机断层扫描显示大量气腹，无气胸、纵隔气肿、腹膜后气肿或皮下气肿，随后的检查未发现中空脏器穿孔。因此，诊断为特发性气腹，对该患者进行了保守治疗，结果成功治愈。这一经验以及文献回顾表明，即使存在腹膜炎的体征和症状，特发性气腹也适合保守治疗。
