Diagnosis and treatment of pediatric benign pneumoperitoneum A case report series of 9 patients
Diagnosis and treatment of pediatric benign pneumoperitoneum A case report series of 9 patients
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DOI：
10.1097/md.0000000000005814
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发表时间：
2017-01-01
期刊：
影响因子：
1.6
通讯作者：
Li, Jian-Hong
中科院分区：
文献类型：
--
作者：
Duan, Shou-Xing;Sun, Zong-Bo;Li, Jian-Hong
前言：良性气腹(BPPT)定义为无症状的腹内游离气体或无腹膜炎的气腹。有症状的游离空气需要手术治疗，但对无症状气腹的处理是有争议的。本研究探讨儿童BPPT的诊断和治疗。临床资料：对2000年1月至2015年1月收治的9例儿童BPPT的临床资料进行回顾性分析，总结其诊断和治疗。共9例，男8例，女1例，年龄4天至4岁。其中新生儿6例(其中早产儿1例)。入院时均以腹胀为主要临床症状，其中呼吸急促2例，呕吐2例，腹泻1例，发热2例。既往无便秘或梗阻排便。6例新生儿出生后24小时内胎粪排出。体格检查显示，除1例腹胀外，其余患者腹壁松弛，肌肉轻度僵硬，肠鸣音多动。结果：除1例剖腹手术外，其余患者均经禁食、预防感染、补液、腹膜穿刺术及密切观察等保守治疗治愈。9例患者全部出院，无死亡病例。出院后随访7个月~6年。结论：BPPT的诊断主要依靠患者的临床表现、仔细的腹部检查、腹部X线片联合腹部穿刺术、排除胃肠道穿孔等。保守治疗可以治愈这种疾病。应注意与外科气腹的鉴别，避免不必要的手术探查。
Introduction: Benign pneumoperitoneum (BPPT) is defined as asymptomatic free intraabdominal air or as pneumoperitoneum without peritonitis. Symptomatic free air requires surgical anagement, but management of asymptomatic pneumoperitoneum is controversial. In this study, we investigate the diagnosis and treatment of BPPT in children.Clinical Findings: The clinical data of 9 pediatric patients with BPPT who were admitted to our hospital from January 2000 to January 2015 were retrospectively analyzed to summarize the diagnosis and treatment. Overall, 9 cases were included with 8 males and 1 female, aged from 4 days to 4 years. Among them there were 6 newborns (including 1 premature infant). Patients were all admitted to hospital with the major clinical symptom of abdominal distension, including 2 cases accompanied by tachypnea, 2 cases with vomiting, 1 case with diarrhea, and 2 cases with fever. No previous constipation or obstructive defecation existed. Six newborns had meconium defecation within 24hours after birth. Physical examination revealed all patients with relaxed abdominal wall except 1 patient with abdominal distension had slight muscle stiffness and hyperactive bowel sounds. Abdominal X-ray suggested free air under the diaphragm in all cases.Interventions/Outcomes: All patients except for one case of laparotomy were conservatively treated and cured with fasting, infection prevention, rehydration, abdominocentesis, and close observation. Nine cases of patients were all discharged with no death occurrence. After discharge follow-up of 7 months to 6 years was conducted. There was no recurrence of similar symptoms, and children were in good growth and development.Conclusion: The diagnosis of BPPT mainly relies on clinical symptoms in patient, careful abdominal examination, abdominal X-ray combined with abdominocentesis, and the exclusion of gastrointestinal perforation for confirmation. Conservative treatment can cure the disease. Attention should be paid to distinguish with surgical pneumoperitoneum to avoid unnecessary surgical exploration.