Pneumoperitoneum Following Blunt Abdominal Injury: Does It Warrant Laparotomy?

Introduction: Intraabdominal injury causes significant morbidity and mortality. Pneumoperitoneum is normally associated with traumatic abdominal injuries. Generally, explorative laparotomy is indicated as part of management in the presence of pneumoperitoneum associated with intraabdominal injury. Case Report: ＂We describe a case of suspected perforated intraabdominal viscus in a ventilated patient based on the presence of air under right diaphragm from chest radiography and the presence of pneumperitoneum from the Computed tomography (CT) scan of the abdomen. The laparotomy revealed intact gastrointestinal (GI) tract and absence of focal injury. Discussion: Radiological finding of air under diaphragm in a patient with pneumothorax or ventilated patient with absence of peritonism needs to be interpreted cautiously. Free intraperitoneal air is not necessarily caused by alimentary tract perforation. Other clinical conditions that may mimic pneumoperitoneum include Chilaiditi syndrome, basal lung bulla, undulating diaphragm, subphrenic abscess due to gas forming organisms, pyonephrosis due to gas forming organisms, subphrenic fat and pneumoretroperitoneum. In such patient, a diagnostic peritoneal lavage (DPL) using Otomo's criteria and cell count ratio is highly predictive of the presence of blunt hollow visceral injury. Conclusion: A diagnostic peritoneal lavage (DPL) after CT scan of abdomen for identifying blunt hollow visceral injury is recommended. The combined application of the two criteria improves the accuracy of diagnosing blunt hollow visceral injury. Appropriate diagnosis prevents unnecessary invasive procedure.

並列關鍵字

Pneumoperitoneum ； Air under diaphragm ； Blunt abdominal injury ； Laparotomy

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