2023 Volume 43 Issue 6 Pages 969-972
The patient was a 69-year-old woman who had been diagnosed as having mixed connective tissue disease (MCTD) 6 years prior to the surgery. A chest X-ray performed for suspected heart failure in the patient revealed free air in the abdomen and the patient was referred for surgery to our department. Even though there was no obvious evidence of inflammation, with a WBC count of 2,700/μL and serum CRP of 0.04mg/dL, and physical examination revealed only abdominal fullness and mild tenderness, we considered that surgery was indicated as the patient was on immunosuppressant treatment and had marked free air in the abdomen and ascites. Laparotomy was performed, and intraoperative exploration revealed only a moderate amount of serous ascites and no obvious perforation. Postoperatively, the patient had some alternating diarrhea and constipation which was difficult to control. She was discharged from the hospital on the 21st postoperative day without other problems. In this report, we describe a case of emergency laparotomy performed on a woman with MCTD who presented with significant abdominal distention, free air in the abdomen, and ascites, without any perforation of the gastrointestinal tract.
