Mularski R A, Ciccolo M L, Rappaport W D
Oregon Health Sciences University, USA.
West J Med. 1999 Jan;170(1):41-6.
The radiographic manifestation of free air in the peritoneal cavity suggests serious intra-abdominal disease and the need for urgent surgical management. Yet, about 10% of all cases of pneumoperitoneum are caused by physiologic processes that do not require surgical management. We retrospectively reviewed cases of nonsurgical causes of pneumoperitoneum at the 2 teaching hospitals of a university medical center between January 1990 and December 1995. Successful management by observation and supportive care without surgical intervention was defined as the diagnostic feature of nonperforation. Failure of a laparotomy to delineate a surgical cause or to result in a reparative procedure is congruent with a nonsurgical cause of pneumoperitoneum. During this period, 8 patients (6 men and 2 women; mean age, 61 years) were identified with nonsurgical causes of pneumoperitoneum. Two patients underwent negative laparotomy, and the other 6 were successfully managed nonoperatively and discharged from the hospital. In 6 patients, a cause of the pneumoperitoneum was identified. The causes may be grouped under the following categories: postoperatively retained air, thoracic, abdominal, gynecologic, and idiopathic. In our review of the literature, 61 of 139 reported cases underwent surgical treatment without evidence of perforated viscus. To avoid unnecessary surgical procedures, both primary medicine physicians and surgeons need to recognize nonsurgical causes of pneumoperitoneum. Conservative management is warranted in the absence of symptoms and signs of peritonitis.
腹腔内游离气体的影像学表现提示存在严重的腹腔内疾病，需要紧急手术处理。然而，所有气腹病例中约10%是由无需手术处理的生理过程引起的。我们回顾性分析了1990年1月至1995年12月间一所大学医学中心的两家教学医院中气腹非手术病因的病例。通过观察和支持治疗而非手术干预获得成功处理被定义为非穿孔的诊断特征。剖腹探查未能明确手术病因或未能进行修复手术与气腹的非手术病因相符。在此期间，确定了8例气腹非手术病因患者（6例男性，2例女性；平均年龄61岁）。2例患者接受了阴性剖腹探查，另外6例通过非手术成功处理并出院。6例患者确定了气腹病因。病因可分为以下几类：术后残留气体、胸部、腹部、妇科及特发性。在我们的文献回顾中，139例报告病例中有61例接受了手术治疗，但未发现脏器穿孔证据。为避免不必要的手术，初级内科医生和外科医生都需要认识到气腹的非手术病因。在没有腹膜炎症状和体征的情况下，保守治疗是合理的。
