The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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A Case of Spontaneous Pneumoperitoneum Caused by Giant Bulla

자발성 기복증으로 발현된 거대 공기집 1예

  • Lee, Key-Jo (Department of Internal Medicine, Seoul Red Cross Hospital) ;
  • Kang, Seok-Woo (Department of Internal Medicine, Seoul Red Cross Hospital) ;
  • Park, Min-Bom (Department of Internal Medicine, Seoul Red Cross Hospital) ;
  • Jeong, Eun-Ho (Department of Internal Medicine, Seoul Red Cross Hospital) ;
  • Kim, Jin-Ou (Department of Internal Medicine, Seoul Red Cross Hospital) ;
  • Wang, Hee-Bae (Department of Internal Medicine, Seoul Red Cross Hospital) ;
  • Kim, Tae-Ho (Department of Internal Medicine, Seoul Red Cross Hospital)
  • Published : 2011.09.01
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Abstract

A spontaneous pneumoperitoneum is air in the peritoneal space that is detectable radiologically and can be managed successfully by observation alone or a laparotomy. A 73-year-old man was admitted for low back pain. He had a giant bulla in the left upper lung, detected radiologically 7 years earlier. On admission, he had free air in the subphrenic area bilaterally, while the previous giant bulla was not seen. Based on the physical examination, we thought that the new free air did not indicate a surgical abdomen, and performed additional examinations to rule out other disease. There was no abnormal finding linked to the free air. The free air had almost disappeared on a subsequent chest X-ray. We report a rare case of spontaneous pneumoperitoneum caused by a giant bulla, with a literature review.

자발성 기복증이 보고된 증례는 흔하지 않으며 특히 거대 공기집에서 발현된 경우는 더욱 희귀한 경우라 할 수 있다. 대부분의 비수술적 기복증의 경우 의사의 진단 가능성을 높여 주는 환자의 과거 병력 또는 연관된 증상을 갖고 있다. 따라서 기복증 환자가 내원하였을 경우 자발성 기복증을 진단하는데 있어 방사선학적 관찰 및 환자의 과거 병력 조사가 선행되어야 하고, 확진되었을 경우 경과관찰 및 대증 치료로 호전을 기대해 볼 수 있다. 그러나 자발성 기복증 환자라도 방사선 사진에서 장파열의 확인, 복막염 징후, 저혈압, 빈맥, 임상 증상의 악화 또는 지속, 백혈구 증가증이 관찰될 경우에는 수술적 처치가 필요하다. 이와 같이 기복증의 비수술적 원인을 판단하는 것은 불필요한 수술적 처치를 피할 수 있고 이는 자세한 신체검사, 검사실 소견, 방사선학적 결과의 주의 깊은 재검토를 통해서 적절한 평가를 할 수 있다.

Keywords

References

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