偽中空器官穿孔的產氣性大腸疾病

Pneumatosis coli with pneumoperitoneum mimicking hallow organ perforation

腹腔內產氣是一個不好且危險的影像表徵，通常代表著嚴重且致命的疾病，例如腸胃道中空藏器穿孔，而這些情況往往需要進行侵入性的手術處置。然而，在一些特殊的情況下，例如沒有腹膜病徵的症狀，以及生命徵象穩定的病人，手術其實是可以避免的。我們提出一位83歲男性病患，主訴發燒和右上腹疼痛一周，被家人帶到我們的急診室。儘管腹部斷層掃描顯示明確的腹腔內產氣，然而它是一種罕見且不需手術介入的大腸產氣性疾病。產氣性大腸疾病是一種罕見的疾病，其表徵為許多充填之囊腫在大腸的漿膜下或粘膜下壁，而當囊腫破裂後，即可能產腹腔內產氣的情況。此疾病常發生在小腸或右側的大腸。造成原因主要有七種來源，分別為腸胃道、醫源性、感染性、自體免疫、肺部、藥物以及外傷性。診斷主要為利用影像檢查，尤其是電腦斷層，所表現的獨特環狀腸內壁空氣模式作為診斷依據。此疾病的處置主要以保守性治療為主，包括抗生素、氧氣以及高壓氧治療。雖然腹腔內產氣的影像是嚴重致命的，但是若病人沒有合併腹膜炎徵候、發燒、或白血球上升，且診斷為大腸產氣性疾病，則可優先考慮內科治療。

 

Pneumoperitoneum is an ominous imaging sign and is frequently seen in conditions that require surgical intervention. However, surgery can be avoided in some unique cases presenting with pneumoperitoneum. We present the case of an 83-year-old man who reported to our emergency department with the chief complaints of fever and right upper quadrant pain for one week. Although abdominal computed tomography revealed definite pneumoperitoneum, it was determined to be a rare case of Pneumatosis coli, wherein surgery could be avoided. Although the diagnosis of pneumoperitoneum is intimidating at best, conservative management should always be considered in cases of minimal abdominal pain and the absence of peritoneal signs, fever, and leukocytosis, as seen in the present case.