Pneumoperitoneum due to pneumothorax in blunt thoracoabdominal trauma: A diagnostic challenge

Luis Miguel Castro,Capella Vanessa,Rui Manuel Mendes,Coelho Fátima Borges,Ávila Leonor

doi:10.34172/jept.2021.30

Luis Miguel Castro, Capella Vanessa + Show 3 more

Open Access

https://doi.org/10.34172/jept.2021.30

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Abstract

Objective: A Perforation of hollow viscus is the most common cause of pneumoperitoneum after a blunt thoracoabdominal trauma and demands prompt surgical exploration. Alternative routes into the peritoneal cavity, such as the presence of a diaphragmatic laceration associated with pneumothorax, although rare, should be considered when approaching these patients. Case Presentation: We present the case of a 78-year-old male admitted to the emergency department after being ran over by a car resulting in right thoracoabdominal trauma, presenting with dyspnea and signs of peritoneal irritation. CT scan identified right pneumothorax, pneumoperitoneum and free abdominal fluid. The pneumothorax was drained and posteriorly he underwent exploratory laparotomy where a traumatic laceration of the diaphragm was identified as the cause of pneumoperitoneum. Conclusion: Alternative causes of pneumoperitoneum should be considered in blunt thoracoabdominal trauma with possibility of conservative management in the absence of peritoneal irritation signs. Pneumothorax drainage is mandatory before intubation to avoid creation of a tension pneumothorax.

Highlights

The presence of pneumoperitoneum after thoracoabdominal trauma is usually caused by perforation of hollow viscus, requiring surgical exploration for sepsis control [1]
Case Presentation A 78-year-old male was admitted in the emergency room after being hit by a car on his right side with complaints of dyspnea and abdominal pain. He presented a respiratory rate of 26 bpm, muffled breath sounds on the right hemithorax, extensive right-sided subcutaneous thoracoabdominal emphysema, tachycardia (120 bpm), blood pressure of 148:70 mm Hg, a Glasgow Coma Scale of 14 and diffuse signs of peritoneal irritation on physical examination
High intensity blunt trauma is associated with a myriad of internal lesions that should be interpreted as a whole clinical picture, alongside with the characteristics of the

Summary

Introduction

The presence of pneumoperitoneum after thoracoabdominal trauma is usually caused by perforation of hollow viscus, requiring surgical exploration for sepsis control [1]. Case Presentation A 78-year-old male was admitted in the emergency room after being hit by a car on his right side with complaints of dyspnea and abdominal pain. On arrival, he presented a respiratory rate of 26 bpm, muffled breath sounds on the right hemithorax, extensive right-sided subcutaneous thoracoabdominal emphysema, tachycardia (120 bpm), blood pressure of 148:70 mm Hg, a Glasgow Coma Scale of 14 and diffuse signs of peritoneal irritation on physical examination. Intra-operative findings included a diaphragmatic laceration of 5 cm (Figure 3), a non-expansive haematoma of the sigmoid mesocolon and the absence of hollow viscus perforation after thorough abdominal exploration. No other adverse events or surgical complications were identified and the patient was discharged on the sixth postoperative day

Discussion

Conclusion