| 词条 | Pneumoperitoneum | ||
| 释义 |
| name = Pneumoperitoneum | image = Pneumoperitoneum modification.jpg | caption = Frontal chest X-ray. The air bubble below the right hemidiaphragm (on the left of the image) is a pneumoperitoneum. | | pronounce = | field = | synonyms = | symptoms = | complications = | onset = | duration = | types = | causes = | risks = | diagnosis = | differential = | prevention = | treatment = | medication = | prognosis = | frequency = | deaths = }} Pneumoperitoneum is pneumatosis (abnormal presence of air or other gas) in the peritoneal cavity, a potential space within the abdominal cavity. The most common cause is a perforated abdominal viscus, generally a perforated peptic ulcer, although any part of the bowel may perforate from a benign ulcer, tumor or abdominal trauma. A perforated appendix seldom causes a pneumoperitoneum. In the mid-twentieth century, an "artificial" pneumoperitoneum was sometimes intentionally administered as a treatment for a hiatal hernia. This was achieved by insufflating the abdomen with carbon dioxide. The practice is currently used by surgical teams in order to perform laparoscopic surgery. Causes
Diagnosis{{anchor|signs}}When present, pneumoperitoneum can often be seen on projectional radiography, but small amounts are often missed, and CT scan is nowadays regarded as a criterion standard in the assessment of a pneumoperitoneum.[6] CT can visualize quantities as small as 5 cm³ of air or gas. Signs that can be seen on projectional radiography are the double wall sign (also called Rigler's sign) and the football sign. The double wall sign marks the presence of air on both sides of the intestine.[7] However, a false double wall sign can result from two loops of bowel being in contact with one another.[8] The sign is named after Leo George Rigler. It is not the same as Rigler's triad. The football sign is when the abdomen appears as a large oval radiolucency reminiscent of an American football on a supine projectional radiograph.[9] The football sign is most frequently seen in infants with spontaneous or iatrogenic gastric perforation causing pneumoperitoneum. It is also seen in bowel obstruction with secondary perforation, as in Hirschprung disease, midgut volvulus, meconium ileus and intestinal atresia. Iatrogenic causes like endoscopic perforation may also give football sign. Differential diagnosisAs differential diagnoses, a subphrenic abscess, bowel interposed between diaphragm and liver (Chilaiditi syndrome), and linear atelectasis at the base of the lungs can simulate free air under the diaphragm on a chest X-ray. TreatmentDepends on causes TerminologyPneumoperitoneum can be described as peritoneal emphysema,[11] just as pneumomediastinum can be called mediastinal emphysema, but pneumoperitoneum is the usual name. See also
References1. ^Necrotizing Enterocolitis Bugs, Drugs and Things That Go Bump in the Night 2. ^{{cite journal|last1=Imran|first1=M.|last2=Bhat|first2=R.|last3=Anijeet|first3=H.|title=Pneumoperitoneum in peritoneal dialysis patients; one centre's experience|journal=Clinical Kidney Journal|volume=4|issue=2|year=2011|pages=120–123|issn=2048-8505|doi=10.1093/ndtplus/sfq208}} 3. ^{{cite journal|last1=Kizer|first1=KW|title=Medical hazards of the water skiing douche.|journal=Ann Emerg Med|date=May 1980|volume=9|issue=5|pages=268–269|pmid=7369581|quote=Many injuries can result from water skiing accidents, but the water skiing "douche" is unique to this sport. Although generally causing only discomfort, significant trauma can result from the forceful entry of water into the various body orifices.}} 4. ^{{cite journal | date = Oct 2000 | pmc = 3113190 | pmid=11051188 | volume=4 | title=Sexual activity as cause for non-surgical pneumoperitoneum | author=Jacobs VR, Mundhenke C, Maass N, Hilpert F, Jonat W | journal=JSLS | pages=297–300}} 5. ^{{cite journal | date = 25 Sep 2013 | pmc = 3113190 | pmid=24121052 | volume=4 | issue=11 | title=Non-surgical pneumoperitoneum after oro-genital intercourse | author=Cawich SO, Johnson PB, Williams E, Naraynsingh V | journal=Int J Surg Case Rep | pages=1048–1051}} 6. ^{{cite web | url = http://www.emedicine.com/radio/topic562.htm | title = eMedicine.com: Pneumoperitoneum | author = Ali Nawaz Khan}} 7. ^Harkin DW, Blake G. Small bowel obstruction in a young adult. Postgrad Med J. 1999 Mar;75(881):173-5. {{PMID|10448501}}. Free Full Text. 8. ^de Lacey G, Bloomberg T, Wignall BK. Pneumoperitoneum: the misleading double wall sign. Clin Radiol. 1977 Jul;28(4):445-8. {{PMID|872511}}. 9. ^{{cite journal |author=Rampton JW |title=The football sign |journal=Radiology |volume=231 |issue=1 |pages=81–2 |date=April 2004 |pmid=14990817 |doi=10.1148/radiol.2311011290 |url=}} 10. ^{{cite web|title=UOTW #68 - Ultrasound of the Week|url=https://www.ultrasoundoftheweek.com/uotw-68/|website=Ultrasound of the Week|accessdate=27 May 2017|date=22 March 2016}} 11. ^{{Citation |last=Marian |first=K |display-authors=etal |year=2015 |title=Spontaneous pneumoperitoneum in a patient after ventilation therapy |journal=Pol Przegl Chir |volume=86 |issue=12 |pages=601–603 |pmid=25803061 |doi=10.1515/pjs-2015-0008 |postscript=.}} External links{{Medical resources| DiseasesDB = 31511 | ICD10 = {{ICD10|K|66|8|k|65}} | ICD9 = {{ICD9|568.89}}, {{ICD9|770.2}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = radio | eMedicineTopic = 562 | MeshID = D011027 }}{{Digestive system diseases}} 2 : Disorders of fascia|Peritoneum disorders |
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