자발성 기복증으로 발현된 거대 공기집 1예

A Case of Spontaneous Pneumoperitoneum Caused by Giant Bulla

  • 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)
  • 발행 : 2011.09.01

초록

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.

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.

키워드

참고문헌

  1. Williams NM, Watkin DF. Spontaneous pneumoperitoneum and other nonsurgical causes of intraperitoneal free gas. Postgrad Med J 1997;73:531-537. https://doi.org/10.1136/pgmj.73.863.531
  2. Mularski RA, Ciccolo ML, Rappaport WD. Nonsurgical causes of pneumoperitoneum. West J Med 1999;170:41-46.
  3. Popper H. Die diagnose der darmperforation mit hilfe der rontgendurchleuchtung. Deutsch Med Wcbnscbr 1915;35:1034-1036.
  4. Dandy WE. Pneumoperitoneum: a method of detecting intestina perforation-an aid in abdominal diagnosis. Ann Surg 1919;70:378-383. https://doi.org/10.1097/00000658-191909000-00008
  5. Vaughan RT, Brams WA. Roentgen-ray in the diagnosis of perforated peptic ulcer. JAMA 1925;85:1876-1878, doi: 10.1001/jama.1925.02670240028008.
  6. Clements WD, Gunna BR, Archbold JA, Parks TG. Idiopathic spontaneous pneumoperitoneum: avoiding laparotomy: a case report. Ulster Med J 1996;65:84-86.
  7. Dodek SM, Friedman JM. Spontaneous pneumoperitoneum. Obstet Gynecol 1953;1:689-698.
  8. Chandler JG, Berk RN, Golden GT. Misleading pneumoperitoneum. Surg Gynecol Obstet 1977;144:163-174.
  9. Derveaux K, Penninckx F. Recurrent "spontaneous" pneumo peritoneum: a diagnostic and therapeutic dilemma. Acta Chir Belg 2003;103:490-492.
  10. Greenberg LF, Kahn SB. Klebsiella pneumonia with pneumothorax, pneumomediastinum and pneumoperitoneum. Dis Chest 1963;53:546-550.
  11. Kadkhodaie HR, Vaziri M. Asymptomatic spontaneous pneumoperitoneum. Shiraz E Med J 2008;9:198-200.
  12. Friedman LJ. The clinical significance of pneumo-peritoneum. Radiology 1934;23:290.
  13. Stilson WL, Neufeld OJ. Spontaneous pneumoperitoneum. Calif Med 1949;70:269-273.
  14. Jeon KN, Bae K, Yoo JJ, Jung SH, Kang DS. Pneumothorax, pneumomediastinum and pneumopericardium: a pictorial review. J Korean Radiol Soc 2004;50:255-262.
  15. Macklin MT, Macklin CC. Malignant interstitial emphysema of the lungs and mediastinum as an important occult complication in many respiratory disease and other conditions: an interpretation of the clinical literature in light of laboratory experiment. Medicine 1944;23:281-358.
  16. Kweon JH, Choi CS, Seo GS, Cho EY, Nah YH, Choi SC. A case of spontaneous pneumomediastinum and pneumoperitoneum. J Wonkwang Med Sci 2006;21:235-239.
  17. Kuroda T, Morikawa H, Satou T, et al. A case of dermatomyositis complicated with pneumomediastinum successfully treated with cyclosporine A. Clin Rheumatol 2003;22:45-48. https://doi.org/10.1007/s10067-002-0675-0
  18. Huh JK, No HS, Lim HH, et al. Subcutaneous emphysema, pneumomediastinum and pneumoperitoneum after colonoscopy. Korean J Med 2009;77:S1153-S1156.
  19. Brown DR, Keenan WJ. Pneumoperitoneum without gastrointestinal perforation in a neonate. J Pediatr 1974;85:377-379. https://doi.org/10.1016/S0022-3476(74)80121-6
  20. Al-Salem AH. Pneumoperitoneum and free meconium without gastrointestinal perforation in a neonate. Saudi Med J 2000;21:680-682.