Significance of intra-abdominal extraluminal air detected by CT scan in blunt abdominal trauma

Abstract

The purpose of this study was to determine the frequency and significance of computed tomographic (CT) scan-detected pneumoperitoneum in blunt abdominal trauma. We retrospectively reviewed 118 consecutive CT scans of the abdomen in blunt abdominal trauma patients (mean Injury Severity Score 24), performed at our Regional Trauma Unit over a 12-month period. Seven (5.9%) patients had intra-abdominal extraluminal air. None of these seven patients had evidence of bowel perforation at laparotomy (two) or on clinical follow-up (five). All seven had chest tubes in place before the CT scan. None of the seven patients were on mechanical ventilation at the time of CT scan. In the setting of blunt abdominal trauma pneumoperitoneum does not necessarily indicate hollow viscus injury. It frequently is secondary to other etiologies, especially dissection of interstitial air from the chest, as suggested in this study. The decision for laparotomy should be based on a combination of the clinical findings, CT scan results, or other diagnostic tests such as peritoneal lavage.