Pneumoperitoneum in the absence of intestinal injury in blunt thoracic and abdominal trauma: A case series with review of literature

Pneumoperitoneum, or free air in the abdominal cavity, usually indicates a surgical emergency due to visceral perforation. However, it can also result from thoracic, reproductive, or other abdominal organs without bowel injury. Air may enter the peritoneal cavity through normal pathways or from post-traumatic thoraco-abdominal injuries. This case series reviews the clinical and radiological features of pneumoperitoneum in blunt thoracic or abdominal trauma without gastrointestinal perforation, and the feasibility of non-operative management in these cases. An analysis of 8 cases revealed that six were managed non-operatively, while 2 underwent surgery. This suggests that pneumoperitoneum can occur without hollow viscus injury in patients with blunt torso injuries. With careful patient selection and in the absence of clinical or imaging evidence of bowel injury, non-operative management can be successful.