Laparoscopic Evaluation of Traumatic Pneumoperitoneum Without Hollow Viscus Injury: A Case Series

The presence of free pneumoperitoneum (free intraperitoneal air) after blunt trauma is generally considered indicative of a hollow viscus perforation, often necessitating emergency surgery. This finding presents a major diagnostic challenge in multiply injured patients. Here, we present three cases of traumatic pneumoperitoneum in multiply injured patients without visceral perforation. All patients had sustained high-energy trauma resulting in severe associated injuries, including thoracic trauma and multiple fractures. Diagnostic laparoscopy was utilized to evaluate the abdomen in each case and successfully ruled out intra-abdominal injuries, thus avoiding the morbidity of an unnecessary laparotomy. Our experience suggests that diagnostic laparoscopy can be a safe and effective tool for the evaluation of hemodynamically stable, multiply injured patients with traumatic pneumoperitoneum of an unclear etiology.