Shahrudin M D
Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur.
Med J Malaysia. 1993 Dec;48(4):449-52.
Spontaneous pneumoperitoneum without peritonitis is a rare phenomenon which poses a dilemma to the surgeons faced with this problem. Two such cases and their outcome are presented. The first case was caused by tracheal rupture during emergency intubation and was treated by observation until complete resolution. The second case was caused by barotrauma during positive pressure ventilation and was treated by laparotomy. Both patients died for reasons unrelated to the pneumoperitoneum. The passage of air from the chest cavity into the abdominal cavity was along the great vessels in the first case and through the diaphragm in the second. A compilation of other aetiologies of pneumoperitoneum without peritonitis as extracted from the literature is presented. In the presence of pneumoperitoneum without peritonitis and when the clinical history does not suggest visceral perforation, an abdominal tap or lavage should be attempted. If negative, continued observation is advised.
无腹膜炎的自发性气腹是一种罕见现象，给面临此问题的外科医生带来了两难困境。本文介绍了两例此类病例及其结局。第一例由紧急插管时气管破裂引起，通过观察直至完全消退进行治疗。第二例由正压通气时的气压伤引起，通过剖腹手术治疗。两名患者均因与气腹无关的原因死亡。在第一例中，空气从胸腔进入腹腔是沿着大血管，在第二例中是通过膈肌。本文还呈现了从文献中提取的无腹膜炎气腹的其他病因汇总。在存在无腹膜炎气腹且临床病史未提示内脏穿孔时，应尝试进行腹腔穿刺或灌洗。如果结果为阴性，建议继续观察。
