A rare case of simultaneous pneumoperitoneum and pneumomediastinum without hollow viscus perforation





Pneumoperitoneum, Pneumomediastinum, Hollow viscus perforation, Conservative management


Traumatic pneumoperitoneum and pneumomediastinum managed conservatively are rare in surgical practice. This report describes an atypical case of 10-year-old male child with pneumoperitoneum, pneumomediastinum, extensive subcutaneous emphysema and an exceptionally rare finding of air in spinal canal, all managed conservatively. We report a case of 10 years old male child who presented with a compressed air injury to the perianal region. On further investigation, a diagnosis of traumatic pneumoperitoneum, pneumomediastinum and subcutaneous emphysema without hollow viscus perforation was established. He was managed conservatively. This case highlights the successful conservative management of child with traumantic pneumoperitoneum and pneumomediastinum. Many times explorative laparotomy is performed based on findings of pneumoperitoneum on abdominal radiograph and computed tomography (CT), which later turns out to be negative. Hence, clinical judgements may override trauma protocols in selected cases. Pneumoperitoneum preceded by a reasonable clinical history in patient with adequate abdominal examination may warrant continued observation, thus avoiding an unnecessary laparotomy.


Hoover EL, Cole GD, Mitchell LS, Adams CZ, Hassett J. Avoiding laparotomy in nonsurgical pneumoperitoneum. Am J Surg. 1992;164:99-103.

Sohrabi C, Mathew G, Maria N, Kerwan A, Franchi T, Agha RA. The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines. Int J Surg. 2023;109(5):1136-40.

Kdkhodaie HR, Vaziri M. Asymptomatic spontaneous pneumoperitoneum. Shiraz E-Med J. 2008;9(4):e93750.

Tanner TN, Hall BR, Oran J. Pneumoperitoneum. Surg Clin North Am. 2018;98:915-32.

Mularski RA, Sippel JM, Osborne ML. Pneumoperitoneum: a review of nonsurgical causes. Crit Care Med. 2000;28:2638-44.

Currin SS, Simmers CD, Tarr GP, Harkness GJ, Mirjalili SA. Benign posttraumatic pseudopneumoperitoneum. AJR Am J Roentgenol. 2017;209:1256-62.

Parvez M D, Supreet K, Ajay S, Subodh K. Intraperitoneal urinary bladder rupture as a cause of pneumoperitoneum. Am Surg. 2023;89:2079-81.

Ubukata Y, Sohda M, Sakai M, Nakazawa N, Hara K, Sano A, et al. Idiopathic pneumoperitoneum diagnosed following high-energy motor vehicular trauma:a case report. J Med Invest. 2022;69(1.2):155-7.

Ramponi DR. Pneumoperitoneum. Adv Emerg Nurs J. 2018;40:87-93.

Abdalla S, Gill R, Yusuf GT, Scarpinata R. Anatomical and Radiological Considerations When Colonic Perforation Leads to Subcutaneous Emphysema, Pneumothoraces, Pneumome-diastinum, and Mediastinal Shift. Surg J. 2018;4:e7-13.

Hekimoğlu E, Turna A, Kara V, Demirkaya A, Kaynak K. Rectosigmoidoscopy complicated by bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and pneumoderma. Ulus Travma Acil Cerrahi Derg. 2017;23:269-71.

Kim BH, Yoon SJ, Lee JY, Moon JE, Chung IS. Subcutaneous emphysema, pneumomediastinum, pneumoretroperitoneum, and pneumoperitoneum secondary to colonic perforation during colonoscopy. Korean J Anesthesiol. 2013;65:S103-4.

Johnson CD, Ellis H. Acute pneumoperitoneum secondary to gastrointestinal perforation. Br J Surg. 2021;108(4):345-56.

Kourounis G, Lim QX, Rashid T, Gurunathan S. A rare case of simultaneous pneumoperitoneum and pneumomediastinum with a review of the literature. Ann R Coll Surg Engl. 2017;99:e241-3.

Falidas E, Anyfantakis G, Vlachos K, Goudeli C, Stavros B, Villias C. Pneumoperitoneum, Retropneumoperitoneum, Pneumomediastinum, and Diffuse Subcutaneous Emphysema following Diagnostic Colonoscopy. Case Rep Surg. 2012;2012:1-4.

Tiwari A, Sharma H, Qamar K, Sodeman T, Nawras A. Recognition of Extraperitoneal Colonic Perforation following Colon-oscopy: A Review of the Literature. Case Rep. Gastroenterol. 2017;11:256-64.






Case Reports