International journal of surgery case reports · 2018
Massive intraperitoneal free air induced by pneumothorax and pneumomediastinum.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Fujiwara Kei, Ohsaka Hiromichi, Nagasawa Hiroki, Takeuchi Ikuto, Jitsuiki Kei, Kondo Akihiko, Omori Kazuhiko, Ishikawa Kouhei, Yanagawa Youichi
Аннотация
INTRODUCTION: Pneumoperitoneum (PP), or air within the abdominal cavity, is frequently a harbinger of serious abdominal pathology and often represents visceral perforation. We herein report a case of combined massive intraperitoneal free air, pneumothorax and pneumomediastinum but emergency laparotomy was negative.
PRESENTATION OF CASE: A sixty-seven-year-old man was found unconscious on a road after being hit by a car. On arrival, he showed swelling of the head and flail chest. Computed tomography (CT) demonstrated cerebral contusion, multiple bilateral rib fractures, minute subcutaneous emphysema and a left hemothorax. As his consciousness and respiratory function deteriorated, tracheal intubation with mechanical ventilation with positive end-expiratory pressure was executed on the second day. On the third day, the CT scan revealed the new appearance of pneumomediastinum and massive free air in his intraperitoneal space. Emergency laparotomy was negative.
DISCUSSION: The 'air leak' phenomenon, in which an alveolar air cell ruptures into the perivascular and peribronchial interstitial tissues, is a well-recognized consequence of positive end-expiratory pressure therapy. Accordingly, the deterioration of traumatic pneumothorax and/or the occurrence of pneumomediastinum after mechanical ventilation was the most likely cause of the PP in the present case. However, it remains possible that a minute unrecognized diaphragmatic injury caused the massive PP in the present case.
CONCLUSION: We herein described a case of PP that occurred after mechanical ventilation in a patient with multiple injuries, but which did not originate from perforation of the gastrointestinal tract. It is most likely that the PP had an intrathoracic cause.
PRESENTATION OF CASE: A sixty-seven-year-old man was found unconscious on a road after being hit by a car. On arrival, he showed swelling of the head and flail chest. Computed tomography (CT) demonstrated cerebral contusion, multiple bilateral rib fractures, minute subcutaneous emphysema and a left hemothorax. As his consciousness and respiratory function deteriorated, tracheal intubation with mechanical ventilation with positive end-expiratory pressure was executed on the second day. On the third day, the CT scan revealed the new appearance of pneumomediastinum and massive free air in his intraperitoneal space. Emergency laparotomy was negative.
DISCUSSION: The 'air leak' phenomenon, in which an alveolar air cell ruptures into the perivascular and peribronchial interstitial tissues, is a well-recognized consequence of positive end-expiratory pressure therapy. Accordingly, the deterioration of traumatic pneumothorax and/or the occurrence of pneumomediastinum after mechanical ventilation was the most likely cause of the PP in the present case. However, it remains possible that a minute unrecognized diaphragmatic injury caused the massive PP in the present case.
CONCLUSION: We herein described a case of PP that occurred after mechanical ventilation in a patient with multiple injuries, but which did not originate from perforation of the gastrointestinal tract. It is most likely that the PP had an intrathoracic cause.