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肛門穿刺傷並壓縮空氣注入造成氣胸、縱膈腔、後腹腔及皮下氣腫：一病例報告
Pneumothorax, Retroperitoneal and Mediastinal Emphysema Caused by Anal Stabbing Injury with Injection of Compressed Air: a Case Report
摘要
壓縮空氣注入人體內的意外傷害雖很少見，但結果從無症狀的皮下氣腫到致命性的器官破裂都有可能，取決於氣體壓力高低，噴入人體位置及噴入氣量多寡。文獻上有眼睛、手掌、食道、大腸等傷害的相關報告，且多和惡作劇有關。今報告一位在修車廠工作的56歲男性，工作時和同事嬉鬧，不慎被壓縮空氣除塵噴槍刺傷肛門，同時噴入大量空氣。臨床表現下腹疼痛但無腹膜症狀，檢查發現在肛門前方齒狀線上有約一公分的黏膜裂傷及0.3公分穿孔，病人呈現嚴重的皮下、後腹腔、縱隔腔氣腫及右側氣胸。根據此病患臨床狀況採取右側胸管引流及保守治療，病患復原良好，第七天皮下氣腫消失，出院後門診追蹤並無後遺症發生。回顧文獻，探討壓縮空氣的物理特性及其意外傷害對人體可能的影響，期給予此顯病患、即時且適當的治療，並藉以強調工業安全，避免意外發生。
並列摘要
Injection of the industrial compressed air into the human body is uncommon; however, it might have lethal outcome. The degree of the severity varying from asymptomatic subcutaneous emphysema to fatal organ perforation depends on the site, the pressure and the volume of the air jet. Injuries of the eyeball, orbitopalpebra, hand, esophagus and colon had been presented in the literature and generally occurred as a result of pranks. We report a rare case of the anal stabbing injury with plenty of compressed air injection simultaneously by the tapering tip of the air duster gun while the patient was playing practical jokes with his coworkers. The physical examinations and roentgenographic studies revealed right side pneumothorax, diffuse subcutaneous, retroperitoneal and mediastinal emphysema. The rigid sigmoidoscope disclosed a 3mm, non-contaminated stabbing perforation on the anterior anal wall at the level of the dentate line. No additional rectosigmoid lesions could be found. After tube thoracostomy and conservative treatment, the patient recovered uneventfully and he was discharged 7 days later. The literature on this condition is reviewed, and the pathophysiology, complication and management are discussed.
延伸閱讀
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