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

A Perforation of hollow viscus is the most common cause of pneumoperitoneumafter a blunt thoracoabdominal trauma and demands prompt surgical exploration.Alternative routes into the peritoneal cavity, such as the presence of a diaphragmaticlaceration associated with pneumothorax, although rare, should be considered whenapproaching these patients.

We present the case of a 78-year-old male admitted to the emergencydepartment after being ran over by a car resulting in right thoracoabdominal trauma,presenting with dyspnea and signs of peritoneal irritation. CT scan identified rightpneumothorax, pneumoperitoneum and free abdominal fluid. The pneumothoraxwas drained and posteriorly he underwent exploratory laparotomy where a traumaticlaceration of the diaphragm was identified as the cause of pneumoperitoneum.

Alternative causes of pneumoperitoneum should be considered in bluntthoracoabdominal trauma with possibility of conservative management in the absenceof peritoneal irritation signs. Pneumothorax drainage is mandatory before intubation toavoid creation of a tension pneumothorax.