腹膜透析相关性腹膜炎合并急腹症1例  

A case of peritoneal dialysis-related peritonitis complicated by acute abdomen

作　　者：石迎花[1] 严丽 SHI Yinghua;YAN Li(Department of Emergency,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院急诊科,武汉430030

出　　处：《临床急诊杂志》2025年第3期227-230,共4页Journal of Clinical Emergency

基　　金：国家自然科学基金资助项目(No:72274067)。

摘　　要：腹膜透析导管为微生物及气体进入维持性腹膜透析患者腹腔提供了通道,易导致腹膜炎及气腹的发生,因此腹膜透析相关性腹膜炎以及气腹在维持性腹膜透析患者中发生率很高。在腹膜透析患者中,气腹并不意味着脏器穿孔。但当腹膜透析患者出现腹膜炎症状,同时影像学检查提示气腹时,须鉴别单纯的腹膜炎、腹膜炎合并脏器穿孔或者其他急腹症合并气腹,临床常出现漏诊或误诊。本文报道1例经剖腹探查确诊为化脓性阑尾炎的维持性腹膜透析合并气腹的患者,为此类患者的诊治提供参考。Peritoneal dialysis catheters provide a pathway for microorganisms and gases to enter the peritoneal cavity of patients undergoing maintenance peritoneal dialysis,which can easily lead to the occurrence of peritonitis and pneumoperitoneum.Consequently,the incidence of peritoneal dialysis-related peritonitis and pneumoperitoneum is high among patients on maintenance peritoneal dialysis.In patients undergoing peritoneal dialysis,pneumoperitoneum does not necessarily imply visceral perforation and does not require immediate surgical intervention.However,when peritoneal dialysis patients present with symptoms of peritonitis and imaging studies suggest pneumoperitoneum,it is necessary to differentiate between simple peritonitis,peritonitis complicated by visceral perforation,or other acute abdominal conditions complicated by pneumoperitoneum,as clinical misdiagnoses or missed diagnoses are common.This article reports a case of a patient on maintenance peritoneal dialysis with pneumoperitoneum who was diagnosed with purulent appendicitis upon laparotomy,providing a reference for the diagnosis and treatment of such patients.

关 键 词：腹膜透析 腹膜炎 气腹 化脓性阑尾炎 急腹症 

分 类 号：R459.5[医药卫生—治疗学]