Zusammenfassung
Blutung, Penetration und Perforation sind häufige Komplikationen peptischer Ulzera.
In 80 % der Fälle ist nach Perforation radiologisch ein Pneumoperitoneum nachweisbar.
Eine Penetration in das Retroperitoneum mit Entwicklung eines Pneumomediastinums ist
selten. Wir berichten über eine 85-jährige Patientin mit rezidivierender Übelkeit,
Erbrechen sowie Appetitlosigkeit. Während der extern durchgeführten Gastroduodenoskopie
entwickelte die Patientin akut Dyspnoe. Radiologisch fand sich ein Pneumomediastinum
mit rechtsseitigem Pneumothorax. Die explorative Laparotomie zeigte ein nach retroperitoneal
penetriertes Ulcus duodeni, welches durch eine B-II-Resektion mit Roux-Y- Anastomose
versorgt wurde. Der postoperative Verlauf war komplikationslos.
Abstract
Haemorrhage, penetration and perforation are common complications of peptic ulcers.
Free intraabdominal air is seen in 80 % after perforation. Penetration into the retroperitoneum
with pneumothorax and mediastinal emphysema are rarely observed. We report the case
of a 85-year-old female patient with nausea, vomitus and inappetance. During endoscopy
of the upper GI-tract she complained about progressive dyspnea. Chest X-ray revealed
mediastinal emphysema and pneumothorax. When performing laparotomy, we found a duodenal
ulcer, that had penetrated the retroperitoneal space. The patient underwent partial
gastrectomy and reconstruction with Billroth-II anastomosis. The postoperative course
was uneventful.
Schlüsselwörter
Ulcus duodeni - Perforation - Pneumothorax - Pneumomediastinum - Hautemphysem
Key words
Duodenal ulcer - penetration - pneumothorax - pneumomediastinum - subcutaneous emphysema
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Dr. med. Martin J. Utzig
Chirurgische Klinik und Poliklinik I · Abteilung für Allgemein-, Gefäß- und Thoraxchirurgie
· Universitätsklinikum Benjamin Franklin
Hindenburgdamm 30
12200 Berlin
Telefon: 0 30/84 45-25 43
Fax: 0 30/84 45-27 40
eMail: martin.utzig@ukbf.fu-berlin.de
