外傷を契機に発見された特発性気腹症の１例

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  • A Case of Idiopathic Pneumoperitoneum Presented with a Trauma.

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A 69-year-old man was transferred to the emergency clinic in our hospital because he suffered bruises the head and abdomen from a traffic accident. CT scan of the head revealed traumatic subarachnoid hemorrhage. Because it was a small amount of hemorrhage, the patient was strictly followed. No abdominal pain was noted, but chest and abdominal plain x-ray films and an abdominal CT scan visualized a massive intraperitoneal free air beneath the bilateral diaphragma. The patient was admitted with a suspicion of traumatic gastrointestinal perforation. The patient became to have a fever between 38 and 39°C and aggravation of inflammatory reaction on the 6th hospital day. Laparoscopic intraabdominal exploration was made on the 8th hospital day. No gastrointestinal perforation was confirmed, and only small amount of bloody ascites was seen in the right side of abdominal cavity and Dougles' pouch. Thereafter no fever nor abdominal pain occurred and the patient was discharged from the hospital on the 24th hospital day. Later, we had an opportunity to see a chest plain x-ray film which had been taken at another hospital before the accident that disclosed the presence of intraabdominal free air beneath the bilateral diaphragma. Accordingly, idiopathic pneumoperitoneum was diagnosed.<br> In instances in which there are no abdominal symptoms despite the presence of intraabdominal free air, idiopathic pneumoperitoneum must be bear in mind as a probable diagnosis.

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