Pneumoperitoneum by Inguinal Laceration after Traffic Accident

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Abdominal Imaging

Background:

• Hollow viscus perforation causes most surgical pneumoperitoneum (approx. 90%).
• Nonsurgical causes account for up to 10% of pneumoperitoneum.
• Pneumoperitoneum presents management challenges, especially without peritonitis or a clear cause.

Observation:

• A 17-year-old male sustained a deep right inguinal laceration after a bicycle-car collision.
• Abdominal exam revealed tenderness but no peritoneal signs; initial chest X-ray showed no subdiaphragmatic free air.
• CT angiography revealed inguinal subcutaneous emphysema and intraperitoneal free air.

Findings:

• Exploratory laparotomy confirmed no bowel perforation.
• A ruptured right femoral sheath with exposed femoral vessels into the peritoneal cavity was identified.
• This case represents the first reported instance of pneumoperitoneum due to inguinal laceration without viscus perforation.

Implications:

• Femoral sheath rupture can cause pneumoperitoneum without hollow viscus perforation in penetrating groin injuries.
• Emergency physicians must consider groin injuries as a potential source of pneumoperitoneum.
• Diagnostic and management strategies for pneumoperitoneum should include evaluation of penetrating injuries to the groin.