I. Overview
Pneumoperitoneum is a pneumothorax. It can be divided into three categories: closed, open and tension. According to the volume of air accumulation and the degree of lung compression, it can be divided into small amount (lung compression <30%), medium amount (lung compression 30-50%) and large amount of pneumothorax (lung compression >50%). Partial pneumothorax must be treated urgently, otherwise it is life-threatening.
Second, clinical characteristics
1.Closed pneumothorax
Characterized by wound closure after air enters the pleural cavity and gas no longer increases. Clinical manifestations depend on the amount and speed of pneumothorax accumulation in the pleural cavity. Patients with a small amount of pneumothorax may be asymptomatic, while a medium to large amount of pneumothorax may present with symptoms such as chest pain, chest tightness and dyspnea.
2.Open pneumothorax
Characterized by communication between the pleural cavity and the outside world, disappearance of negative pressure in the pleural cavity, intrathoracic pressure almost equal to atmospheric pressure, and atrophy of the injured side of the lung. The pressure in the pleural cavity on both sides is unbalanced during inhalation and exhalation, and mediastinal flutter occurs. The patient has obvious respiratory difficulty and heavy symptoms.
3.Tension pneumothorax
The characteristic is that the lung, bronchus or chest wall injury wound forms a live valve, causing gas to enter the pleural cavity during inspiration and the live valve to close during expiration, so that gas only enters and does not leave. The patient’s symptoms are extremely serious, mostly accompanied by extensive subcutaneous emphysema, severe dyspnea, cyanosis, shock, etc.
Diagnosis
1. Medical history; history of trauma, etc.
2.Open pneumothorax has obvious sucking characteristic sound, and there is a wound with the outside world can confirm the diagnosis; tension pneumothorax shows extremely serious dyspnea, subcutaneous emphysema, etc., and puncture suction can confirm the diagnosis.
3.Stable condition can be diagnosed by chest X-ray. If necessary, CT examination of the chest can be performed.
IV. Treatment
1.Closed pneumothorax
Small amount of pneumothorax: lung compression <30%, no obvious conscious symptoms, can be observed, 1-2 weeks gas can be absorbed by itself.
Medium-large pneumothorax: closed chest drainage to remove gas and promote lung reopening.
2.Open pneumothorax
The chest wall defect should be closed quickly to make it into a closed pneumothorax, and then treated according to the principles of closed pneumothorax treatment.
3.Tension pneumothorax
The situation is urgent, immediate exhaust decompression, can be exhausted with a thick needle or immediately perform closed chest drainage.