Pneumoperitoneum due to pneumothorax in blunt thoracoabdominal trauma: A diagnostic challenge

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.