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Case Report
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| Pneumoperitoneum following blunt abdominal injury: Does it warrant laparotomy? |
| Rashidi Ahmad1, Nasir Mohamad1, Abdul Kursi Abdul Latiff1, Zaidah Ahmad2, Ilya Irinaz Idrus1 |
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1Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kelantan, Malaysia.
2Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kelantan, Malaysia. |
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doi:10.5348/ijcri-2011-12-76-CR-6
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Address correspondence to: Nasir Mohamad Senior Lecturer/ Emergency Physician Department of Emergency Medicine School of Medical Sciences, Health Campus USM 16150 Kubang Kerian, Kelantan Malaysia Phone: +6097676978 Fax: +6097673219 Email: drnasirmohamadkb@yahoo.com |
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| How to cite this article: |
| Ahmad R, Mohamad N, Latiff AKA, Ahmad Z, Idrus II. Pneumoperitoneum following blunt abdominal injury: Does it warrant laparotomy? International Journal of Case Reports and Images 2011;2(12):23-27. |
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Abstract
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Introduction:
Intraabdominal injury causes significant morbidity and mortality. Pneumoperitoneum is normally associated with traumatic abdominal injuries. Generally, explorative laparotomy is indicated as part of management in the presence of pneumoperitoneum associated with intraabdominal injury.
Case Report: We describe a case of suspected perforated intraabdominal viscus in a ventilated patient based on the presence of air under right diaphragm from chest radiography and the presence of pneumperitoneum from the Computed tomography (CT) scan of the abdomen. The laparotomy revealed intact gastrointestinal (GI) tract and absence of focal injury. Discussion: Radiological finding of air under diaphragm in a patient with pneumothorax or ventilated patient with absence of peritonism needs to be interpreted cautiously. Free intraperitoneal air is not necessarily caused by alimentary tract perforation. Other clinical conditions that may mimic pneumoperitoneum include Chilaiditi syndrome, basal lung bulla, undulating diaphragm, subphrenic abscess due to gas forming organisms, pyonephrosis due to gas forming organisms, subphrenic fat and pneumoretroperitoneum. In such patient, a diagnostic peritoneal lavage (DPL) using Otomo's criteria and cell count ratio is highly predictive of the presence of blunt hollow visceral injury. Conclusion: A diagnostic peritoneal lavage (DPL) after CT scan of abdomen for identifying blunt hollow visceral injury is recommended. The combined application of the two criteria improves the accuracy of diagnosing blunt hollow visceral injury. Appropriate diagnosis prevents unnecessary invasive procedure. | |
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Key Words:
Pneumoperitoneum, Air under diaphragm, Blunt abdominal injury, Laparotomy
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Author Contributions:
Rashidi Ahmad - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Nasir Mohamad - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Abdul Kursi Abdul Latiff - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Zaidah Ahmad - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published Ilya Irinaz Idrus - Acquisition of data, Drafting the article, Final approval of the version to be published |
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Guarantor of submission:
The corresponding author is the guarantor of submission. |
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Source of support:
None |
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Conflict of interest:
Authors declare no conflict of interest. |
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Copyright:
© Rashidi Ahmad et al. 2011; This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see www.ijcasereportsandimages.com /copyright-policy.php for more information.) et. al. 2011; This article is distributed the terms of Creative Commons attribution 3.0 License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.) |
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