Thoracoabdominal Trauma with Delayed Pneumoperitoneum: A Management Challenge
Amit Ganguly1*, Suraj Verma2, Alok Udiya3, Ravi Masand4 and Shiv Shankar Sharma5
Pneumoperitoneum typically indicates intra-abdominal hollow viscus perforation and more often than not requires emergency surgery. We report a rare case of delayed pneumoperitoneum following thoracoabdominal trauma without evidence of gastrointestinal perforation. A 39-year-old male sustained blunt thoracoabdominal trauma with Grade III-IV liver injury, multiple right rib fractures (3-7), and lung contusion. Delayed pneumoperitoneum developed 48 hours post-trauma without associated pneumothorax, subcutaneous emphysema, or pneumomediastinum. Conservative management was successful, avoiding unnecessary surgical intervention. Delayed pneumoperitoneum following thoracoabdominal trauma may occur through the Macklin effect without hollow viscus perforation. Clinical stability and careful monitoring can guide conservative management decisions.
