Pneumoperitoneum without significant bowel perforation in patients with blunt trauma: a systematic review and meta-analysis

A noteworthy subgroup of patients with blunt trauma with CT-detected FIA did not exhibit clinically significant bowel perforations. Although FIA remains an important radiologic warning sign, it is not an independent diagnostic indicator of significant hollow viscus injury. Clinical decision-making should integrate clinical assessment with adjunctive CT findings rather than rely on FIA alone. Owing to the rarity of FIA and limited sample sizes, larger prospective studies are required to refine the diagnostic performance of FIA and optimize selective nonoperative management strategies.