[A difficult therapeutic dilemma: pneumoperitoneum in severe blunt injuries treated by respiratory or cardiorespiratory resuscitation]

In the particular context of severe blunt trauma treated with cardiorespiratory resuscitation or, more simply, with positive-pressure ventilation, the occurrence of pneumoperitoneum always raises difficult problems of etiological diagnosis, which in turn lead to a difficult dilemma on the treatment to adopt. In fact, while the air released by the alveolar baro-trauma can, once a given pressure is exceeded, migrate into the retroperitoneum and produce a non-surgical pneumascos (for which the other possible causes are far more exceptional, and rather are unpleasant surprises, such as this orogenital induced PPT in Gantt's female patient, conversely the pressurized air from true ruptures of intraabdominal hollow organs may migrate into the mediastinum and cause a thoracic air leakage syndrome that perfectly simulates this pulmonary baro-trauma. Therefore all the paraclinical means required must be used to confirm--or rule out--this diagnosis of perforation, which demands emergency surgery. However, if there is any doubt, the consensus is that emergency surgery is recommended as it is better to accept blank laparotomy than to oversee a gastrointestinal rupture with all its severe complications of evolution.