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. 2014;5(12):1106-9.
doi: 10.1016/j.ijscr.2014.11.022. Epub 2014 Nov 13.

Pneumoperitoneum in a patient with pneumothorax and blunt neck trauma

Suhail Yaqoob Hakim  1 , Husham Abdelrahman  2 , Insolvisagan Natesa Mudali  1 , Ayman El-Menyar  3 , Ruben Peralta  1 , Hassan Al-Thani  1
Affiliations

Pneumoperitoneum in a patient with pneumothorax and blunt neck trauma

Suhail Yaqoob Hakim et al. Int J Surg Case Rep. 2014.

Abstract

Introduction: Blunt trauma as a cause of pneumoperitoneum is less frequent and its occurrence without a ruptured viscus is rarely seen.

Presentation of case: We report a case of blunt neck trauma in which a motorcycle rider hit a fixed object causing severe laryngotracheal injury. The patient developed pneumothorax bilaterally and had pneumoperitoneum despite no injury to the internal viscus. Bilateral chest tube drainage and abdominal exploratory laparotomy was performed.

Conclusion: Free air in the abdomen after blunt traumatic neck injury is very rare. If pneumoperitoneum is suspected in the presence of pneumothorax, exploratory laparotomy should be performed to rule out intraabdominal injury. As, there is no consensus for this plan yet, further prospective studies are warrant. Conservative management for pneumoperitoneum in the absence of viscus perforation is still a safe option in carefully selected cases.

Keywords: Blunt trauma; Laryngotracheal injury; Pneumoperitoneum; Pneumothorax.

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Figures

Fig. 1
Fig. 1
Chest X-ray showing pneumothorax, extensive surgical emphysema.
Fig. 2
Fig. 2
Neck CT scan at the level of the thoracic inlet showing extensive surgical emphysema, dissection of the fascial planes of the neck and both shoulders.
Fig. 3
Fig. 3
CT chest showing bilateral pneuomthorax, pneumomediastium and extensive surgical emphysema.
Fig. 4
Fig. 4
(a, b) CT abdomen showing pneumoperitinneum and surgical emphysema.
Fig. 5
Fig. 5
CT angio: Left vertebral artery occlusion.
See this image and copyright information in PMC

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