Künt Travma Sonrası Pnömotorakssız Pnömoperitoneum

Yıl 2017, , 255 - 258, 01.12.2017

Mesut Yur , Mehmet Şirik Cengiz Ömer Özdemir

https://doi.org/10.5505/kjms.2017.36693

Öz

Pnömoperitoneum, %85-90 oranında visseral perforasyon olması nedeni ile acil cerrahiyi gerektirir. Visseral perforasyonun olmadığı spontan pnömoperitoneum cerrahların karşılaştığı nadir bir durumdur. Biz burada künt travma sonrası 12. torakal vertebrada çökme fraktürlü pnömoperitoneumu olan bir olguyu sunduk. 27 yaşında bir erkek hasta endüstriyel bir kaza sonrası acil servise getirildi. Glaskov koma skoru 15 idi ve karın fizik muayenesinde hassasiyet ve defans vardı. Bilgisayarlı tomografisi bize 12. torakal vertebrada çökme kırığı ve karaciğer anteriorunda serbest hava gösteriyordu. İlk olarak laparotomi yapıldı ancak karın içi serbest havayı açıklayacak bir patoloji bulunamadı. Karın kapatıldıktan sonra vertebra için enstrumantasyon yapıldı. Hasta postoperatif 4.gün taburcu edildi ama pnömoperitoneumun nedeni hala bilinmiyor. Pnömotoraksın olmadığı künt travma sonrası, yalnız pnömoperitoneum, cerrahi veya konservatif tedavi acısından cerrahlar için zor bir durumdur.

Anahtar Kelimeler

Pnömoperitoneum, künt travma, akut karın

Pneumoperitoneum Without Pneumothorax After Blunt Trauma

Öz

Pneumoperitoneum usually indicates a surgical emergency because of visceral perforation in 85 to 95% of cases. Spontaneous pneumoperitoneum without any visceral perforation is a rare condition that surgeons faced with this problem. We reported a case of pneumoperitoneum with burst fracture of thoracal 12nd spine after a blunt trauma. A 27 years old man presented to emergency service after an industrial accident. His glasscow coma score was 15 and in his abdominal examination, there was tenderness and musculer defense. Ct scan showed us free abdominal air antreior of the liver and burst fracture of thoracal 12nd spine. Firstly, laparotomy was performed but we couldn’t observe any identifiable pathology for free air in abdomen. After closure of abdomen, enstrumantation was performed for the spine. The patient was discharged on the 4nd postoperative day, but the cause of pneumoperitoneum remained obscure. After blunt trauma without pneumothorax, lonely pneumoperitoneum is a difficult problem for surgeons to operative or conservative treatment.

Anahtar Kelimeler

Pneumoperitoneum, blunt trauma, acute abdomen

Kaynakça

• 1. MD magazine, Idiopathic pnemoperitoneum after blunt chest trauma, http://www. mdmag. com/journals/surgical-roun ds/2008/2008–04/2008–04_02/;2008.
• 2. Pitiakoudis M, Zezos P, Oikonomou A, Kirmanidis M, Kouklakis G, Simopoulos C. Spontaneous idiopathic pneumoperitoneum presenting as an acute abdomen: a case report. J Med Case Rep 2011;5:86.
• 3. Mularki RA, Mularski RA, Ciccolo ML, Rappaport WD. Nonsurgical causes of pneumoperitoneum. West J Med 1999;170(1):41–6.
• 4. Nayak Samir R, Anindita Mishra, Soren Dilip Kumar, S. Nagendra Babu Spontaneous pneumoperıtoneum following blunt trauma chest - diagnostic dilemma - role of diagnostic laparoscope - a case report IJCRR 2013;5(10):51–6.
• 5. Di Saverio S, Filicori F, Kawamukai K, Boaron M, Tugnoli G. Combined pneumothorax and pneumoperitoneum following blunt trauma: an insidious diagnostic and therapeutic dilemma. postgrad med j 2011;87:75–8.
• 6. Gantt CB Jr, Daniel WW, Hallenbeck GA. Nonsurgical pneumoperitoneum. Am J Surg 1977;134(3):411–4.
• 7. O. Anderson, A. Yaakub, A. Sinha. Pneumoperitoneum associated with pneumopericardium and pneumomediastinum following blunt chest trauma. Injury Extra 2007;38:439–41.
• 8. Marco Assenza, Fabiola Passafiume, Lorenzo Valesini, Leonardo Centonze, Valentina Romeo, Claudio Modini. Pneumomediastinum and Pneumoperitoneum after Blunt Chest Trauma: The Macklin Effect. J Trauma Treatment 2012;1:107.
• 9. Ahmad R, Mohamad N, Latiff AKA, Ahmad Z, Idrus II. Pneumoperitoneum following blunt abdominal injury: Does it warrant laparotomy? International Journal of Case Reports and Images 2011;2(12):23–7.
• 10. Nishina M, Fujii C, Ogino R, Kobayashi R, Kohama A. Pneumoperitoneum and pneumoretroperitoneum in blunt trauma patients. J Trauma 2000;49:565–6.
• 11. Marek AP, Deisler RF, Sutherland JB, Punjabi G, Portillo A, Krook J, et al. CT scan-detected pneumoperitoneum: an unreliable predictor of intra-abdominal injuryin blunt trauma. Injury 2014;45(1):116–21.