Pneumoperitoneum as the presenting sign of pulmonary barotrauma during artificial ventilation

Massive pneumoperitoneum developing immediately following initiation of artificial ventilation is an unusual sign of pulmonary barotrauma, and must be distinguished from pneumoperitoneum following rupture of a hollow abdominal viscus. We present a case of massive pneumoperitoneum and scrotal pneumatocele which we attributed to pulmonary barotrauma after excluding other causes. Awareness of this entity will enable early diagnosis and avoid unnecessary laparotomy.