Objective: A Perforation of hollow viscus is the most common cause of pneumoperitoneum
after a blunt thoracoabdominal trauma and demands prompt surgical exploration.
Alternative routes into the peritoneal cavity, such as the presence of a diaphragmatic
laceration associated with pneumothorax, although rare, should be considered when
approaching these patients.
Case Presentation: We present the case of a 78-year-old male admitted to the emergency
department after being ran over by a car resulting in right thoracoabdominal trauma,
presenting with dyspnea and signs of peritoneal irritation. CT scan identified right
pneumothorax, pneumoperitoneum and free abdominal fluid. The pneumothorax
was drained and posteriorly he underwent exploratory laparotomy where a traumatic
laceration of the diaphragm was identified as the cause of pneumoperitoneum.
Conclusion: Alternative causes of pneumoperitoneum should be considered in blunt
thoracoabdominal trauma with possibility of conservative management in the absence
of peritoneal irritation signs. Pneumothorax drainage is mandatory before intubation to
avoid creation of a tension pneumothorax.