Mezghebe H M, Leffall L D, Siram S M, Syphax B
Department of Surgery, Howard University Hospital, Washington, D.C. 20060.
Am Surg. 1994 Sep;60(9):691-4.
The most common cause of pneumoperitoneum is iatrogenic postsurgical free air that enters the abdominal cavity during laparotomy. In these patients, pneumoperitoneum usually resolves within the first week of surgery and laparoscopic procedures. In patients who have not had recent laparotomy or laparoscopy, pneumoperitoneum indicates rupture of an intra-abdominal viscus in about 90 per cent of the time. Perforated gastric and duodenal ulcers account for the greatest number of these cases. The other 10 per cent are due to a variety of nonsurgical causes that can often be treated by supportive and non-operative measures. Lack of clinical awareness about these small but significant subset of patients who present with spontaneous benign pneumoperitoneum is a source of needless laparotomies that can at times lead to serious postoperative complications. Benign pneumoperitoneum can be categorized according to the source of the gas as suggested by Gantt. The thoracic cavity is by far the most common source, followed by the GI and female genital tracts and a host of other miscellaneous causes. We report here six patients who presented to Howard University Hospital with nonsurgical pneumoperitoneum. Four of these patients underwent negative laparotomies and one died postoperatively. The most common causes of benign pneumoperitoneum are discussed and a review of the literature is presented.
气腹最常见的原因是医源性手术后游离气体，其在剖腹手术期间进入腹腔。在这些患者中，气腹通常在手术和腹腔镜手术的第一周内消散。在近期未进行剖腹手术或腹腔镜检查的患者中，气腹在约90%的情况下提示腹腔内脏器破裂。胃和十二指肠溃疡穿孔占这些病例的最大比例。另外10%是由多种非手术原因引起的，这些原因通常可通过支持性和非手术措施进行治疗。对这些出现自发性良性气腹的小但重要的患者亚组缺乏临床认识，是导致不必要剖腹手术的原因，有时会导致严重的术后并发症。良性气腹可根据甘特所建议的气体来源进行分类。胸腔是迄今为止最常见的来源，其次是胃肠道和女性生殖道以及许多其他杂项原因。我们在此报告6例因非手术性气腹就诊于霍华德大学医院的患者。其中4例患者剖腹探查结果为阴性，1例患者术后死亡。本文讨论了良性气腹最常见的原因并对文献进行了综述。
