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Non-perforated Traumatic Pneumoperitoneum in Maxillofacial Trauma: A Compelling Case Report.
Divakar Goyal1, Aarushi Madaan2, Nitin Goyal3
1Trauma Surgery and Critical Care, All India Institute of Medical Sciences, Bathinda, Bathinda, IND.
Cureus
|February 12, 2024
Summary
Pneumoperitoneum, often from gastrointestinal perforation, can occur without clear cause after trauma. This case highlights a rare instance following facial fractures, suggesting a need for revised management protocols to avoid unnecessary surgery.
Area of Science:
- Trauma surgery
- Emergency medicine
- Radiology
Background:
- Pneumoperitoneum usually indicates gastrointestinal perforation and is managed with exploratory laparotomy.
- Non-surgical causes are known, but unexplained pneumoperitoneum post-laparotomy is rare.
Observation:
- A 22-year-old male with panfacial fractures from a high-velocity road traffic injury presented with subcutaneous emphysema, pneumomediastinum, and pneumoperitoneum.
- No intra-abdominal source for the pneumoperitoneum was identified even after laparotomy.
Findings:
- The patient's pneumoperitoneum was attributed to severe facial trauma and associated air tracking, not gastrointestinal perforation.
- This case represents a rare presentation of pneumoperitoneum secondary to extensive craniofacial injury.
Implications:
- Challenges the standard diagnostic and management pathway for pneumoperitoneum in trauma patients.
- Suggests a need for a revised management protocol to prevent unnecessary laparotomies in similar complex trauma cases.
- Contributes to understanding rare pneumoperitoneum etiologies and informs clinical decision-making.
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