Benign Posttraumatic Pseudopneumoperitoneum复制标题

良性创伤后假性气腹

Pneumoperitoneum detected in the setting of blunt trauma has classically been thought of as highly suggestive of perforated viscus, requiring urgent laparotomy and surgical repair in the absence of other recognized causes. With the widespread adoption of CT in evaluating trauma patients, identification of small, apparently intraperitoneal, locules of gas is a frequent event; however, many of these patients do not have a perforated viscus. Abdominal ectopic gas is a well-recognized phenomenon in patients with pneumomediastinum and pulmonary interstitial air. The pulmonary interstitial air is able to track centrally along the bronchovascular bundles down a pressure gradient into the mediastinum by a process known as the Macklin effect. The mediastinal gas is then able to migrate caudally along fascial planes via two main pathways: The first pathway is posteriorly through the diaphragmatic hiatuses into the retroperitoneum, and the second pathway is anteriorly from the chest wall into the extraperitoneal space through the Morgagni foramen or along the internal thoracic and superior epigastric vessels. The caudal migration of mediastinal gas through these fascial planes into the extraperitoneal space can resemble pneumoperitoneum. The formation of abdominal ectopic gas via this mechanism has been described in patients on mechanically assisted ventilation, patients who have sustained traumatic alveolar rupture or a tracheobronchial injury, and patients with chest tubes in situ.

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