Cohen M E, Kleinman M S
Department of Medicine, Strong Memorial Hospital, University of Rochester School of Medicine and Dentistry, New York, USA.
Am J Gastroenterol. 1997 Dec;92(12):2306-7.
Pneumomediastinum can be caused by gas dissecting along fascial tissue planes into the mediastinum from remote locations, including the retroperitoneum. One potential source of retroperitoneal gas is the colon. We present the third reported case of pneumomediastinum (plus pneumothorax and subcutaneous emphysema) without free intraperitoneal gas developing during an attack of ulcerative colitis. Because there was no colonic perforation noted at colectomy, the extracolonic gas was presumed to originate from a microscopic or partial thickness perforation of the colon. GI perforation must be considered not only in patients who have free intraperitoneal gas but also in those who present with symptoms, signs, or studies consistent with retroperitoneal gas, such as subcutaneous emphysema, pneumomediastinum, or pneumothorax.
纵隔气肿可由气体沿筋膜组织平面从远处部位（包括腹膜后间隙）扩散至纵隔引起。腹膜后气体的一个潜在来源是结肠。我们报告了第三例在溃疡性结肠炎发作期间出现纵隔气肿（伴有气胸和皮下气肿）且无游离腹腔内气体的病例。由于在结肠切除术中未发现结肠穿孔，推测结肠外气体源自结肠的微小或部分厚度穿孔。不仅腹腔内有游离气体的患者要考虑胃肠道穿孔，出现与腹膜后气体相符的症状、体征或检查结果（如皮下气肿、纵隔气肿或气胸）的患者也应考虑。
