- 期刊
Misinterpretation of Pneumoperitoneum in Thoracoabdominal Injuries: Report of Two Cases
胸腹部外傷病患腹內氣體的錯誤判讀：兩例報告
摘要
腹部鈍傷引起的大腸破裂並不常見，如果延遲診斷，會造成不好的預後，所以早期的修補很重要。我們報告兩位因腹部鈍傷且伴有胸部外傷造成的大腸破裂病患。因爲對這樣的傷害不熟悉，外科醫師誤認爲腹部的空氣來自於胸部，造成診斷上的困難。其中一位病患及時發現，並及時修補，而另外一個病患卻因爲延遲治療，造成敗血症而造成腦部永久傷害。在多重外傷的病患，尤其在急診情況，很難診斷出大腸損傷。然而，任何懷疑的腹部內氣體應該要仔細的評估，醫師應該不能只有依賴影像診斷，進一步侵入性的檢查如腹腔鏡或腹膜內沖洗來進一步排除應該被考慮。
關鍵字
無資料並列摘要
Colon perforation caused by blunt abdominal trauma is rare and the correct early diagnosis of this condition may be difficult. However, a delayed diagnosis may prove serious, and early repair of the perforation is critical. We report two cases of colon perforation caused by abdominal blunt contusion with combined thoracic injury. Due to the rarity of and the unfamiliarity with such injury, surgeons misinterpreted the finding in computed tomography scans as abdominal air coming from the thoracic injury and the diagnoses were difficult in both cases. In one patient the condition was discovered in time, and the perforation was properly repaired, while a delay in the other resulted in sepsis with permanent brain damage. Perforation of the colon is sometimes difficult to diagnose in emergency medical care situations, especially in multiple-trauma patients. Nevertheless, any suspicion of pneumoperitoneum should be cautiously investigated and physicians should not only depend on the image diagnosis but also consider further invasive procedures such as laparoscopy or diagnostic peritoneal lavage to exclude possible hollow viscus injury.