[A case of status asthmaticus complicated by with pneumoperitoneum during mechanical ventilation therapy].
A 46-year-old woman was admitted to our hospital for a severe asthma attack. On admission, systemic cyanosis was observed, and her consciousness state was drowsy. Arterial blood gas showed severe respiratory acidosis, hypoxia, and hypercapnea, with pH, PaO2, and PaCO2 of 7.163, 29.9 torr and 81.3 torr, respectively. Immediately, mechanical ventilation was commerced but on the third hospital day pneumomediastinum and subcutaneous emphysema appeared, and on the sixth day pneumoperitoneum also appeared. The chest CT scan on the sixth day showed free air around bilateral internal mammary vessels. This indicated that air moved from the mediastinum into the peritoneal cavity through an anterior route, via the sternocostal triangle formed by the xiphoid origins of the diaphragm medially and the costal origins laterally.
Kiryu
T
T
Third Department of Internal Medicine, National Defense Medical College, Saitama, Japan.
Kobayashi
H
H
Kawaguchi
S
S
Kanou
S
S
Uwabe
Y
Y
Sakai
M
M
Matsuoka
T
T
Nagata
N
N
D005260:Female; D006801:Humans; D008478:Mediastinal Emphysema / Q000209:etiology; D008875:Middle Aged; D011027:Pneumoperitoneum / Q000209:etiology*; D012121:Respiration, Artificial / Q000009:adverse effects; D013224:Status Asthmaticus / Q000150:complications* / Q000628:therapy; D013352:Subcutaneous Emphysema / Q000209:etiology