Misinterpretation of Pneumoperitoneum in Thoracoabdominal Injuries: Report of Two Cases

Abstract

Colon perforation caused by blunt abdominal trauma is rare and the correct early diagnosis of this condition may be difficult. However, a delayed diagnosis may prove serious, and early repair of the perforation is critical. We report two cases of colon perforation caused by abdominal blunt contusion with combined thoracic injury. Due to the rarity of and the unfamiliarity with such injury, surgeons misinterpreted the finding in computed tomography scans as abdominal air coming from the thoracic injury and the diagnoses were difficult in both cases. In one patient the condition was discovered in time, and the perforation was properly repaired, while a delay in the other resulted in sepsis with permanent brain damage. Perforation of the colon is sometimes difficult to diagnose in emergency medical care situations, especially in multiple-trauma patients. Nevertheless, any suspicion of pneumoperitoneum should be cautiously investigated and physicians should not only depend on the image diagnosis but also consider further invasive procedures such as laparoscopy or diagnostic peritoneal lavage to exclude possible hollow viscus injury.