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Zentralbl Chir 2002; 127(12): 1091-1093
DOI: 10.1055/s-2002-36471
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© Georg Thieme Verlag Stuttgart · New York

Pneumomediastinum und Pneumothorax als Manifestation eines Ulcus duodeni - Fallbeschreibung

Duodenal ulcer presenting as pneumomediastinum and pneumothorax - case reportM. J. Utzig1 , Th. Foitzik1 , H. J. Buhr1 , P. Schneider1
  • 1Chirurgische Klinik und Poliklinik I, Allgemein-, Gefäß- und Thoraxchirurgie, Univ.-Klinikum Benjamin Franklin, Freie Universität Berlin
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Publication History

Publication Date:
03 January 2003 (online)

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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

Phone: 0 30/84 45-25 43

Fax: 0 30/84 45-27 40

Email: martin.utzig@ukbf.fu-berlin.de

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