Conservative management of traumatic pneumoperitoneum in a child
Keywords:Paediatric trauma, Pneumoperitoneum, Conservative, Child
Clinical practice guidelines for blunt trauma abdomen in children and adults advocate exploratory laparotomy when free air is detected on imaging. This conventional algorithmic approach of taking up for surgery when pneumoperitoneum is picked up, has its pitfalls as is illustrated in the case study where a child with polytrauma was managed conservatively despite free air on computed tomography (CT). The role of CT to detect bowel perforation, reasons for false positivity of free air in the abdomen and the key points in the successful non-operative treatment of the child have been discussed. Unlike, the only other report in a child with conservative management of pneumoperitoneum where the pneumoperitoneum can be explained secondary to blunt trauma chest, our report was unique in having other markers of bowel injury on CT and was in the absence of chest trauma. Response to injury in children is different compared to adults and allows for a higher success rate in conservative management. Hence, clinical judgement may override trauma protocols in select cases.
WHO. Fact sheet: Ten strategies for keeping children safe on the road, 2015. Available at: https://www.who.int/roadsafety/week/2015/Final_A4_format_Infographic.pdf?ua=1. Accessed on 01 June 2022.
WHO. Fact sheet: Child and adolescent injury prevention: a WHO plan of action 2006-2015, 2006. Available at: https://apps.who.int/iris/handle/. Accessed on 01 June 2022.
Hamilton P, Rizoli S, McLellan B, Murphy J. Significance of intra-abdominal extraluminal air detected by CT scan in blunt abdominal trauma. J Trauma. 1995;39(2):331-3.
Wintermark M, Schnyder P. The Macklin effect: a frequent etiology for pneumomediastinum in severe blunt chest trauma. Chest. 2001;120:543-7.
Currin SS, Simmers CD, Tarr GP, Harkness GJ, Mirjalili SA. Benign posttraumatic pseudopneumoperitoneum. Am J Roentgenol. 2017;209(6):1256-62.
Yanagawa Y, Ohsaka H, Jitsuiki K, Yoshizawa T, Takeuchi I, Omori K, et al. Vacuum phenomenon. Emerg Radiol. 2016;23(4):377-82.
Mesut YU, Şirik M, Özdemir CÖ. Pneumoperitoneum Without Pneumothorax After Blunt Trauma. Kafkas Tip Bilimleri Dergisi. 2017;7(3):255-8.
Hefny AF, Kunhivalappil FT, Matev N, Avila NA, Bashir MO, Abu-Zidan FM. Usefulness of free intraperitoneal air detected by CT scan in diagnosing bowel perforation in blunt trauma: experience from a community-based hospital. Injury. 2015;46(1):100-4.
Bulas DI, Taylor GA, Eichelberger MR. The value of CT in detecting bowel perforation in children after blunt abdominal trauma. AJR Am J Roentgenol. 1989;153(3):561.
Sato T, Hirose Y, Saito H, Yamamoto M, Katayanagi N, Otani T, et al. Diagnostic peritoneal lavage for diagnosing blunt hollow visceral injury: the accuracy of two different criteria and their combination. Surg Today. 2005;35(11):935-9