Presentation
Abdominal discomfort after having a few stabs in the abdomen. No clinical sign of peritonitis. Hemodynamically stable. The fast scan was negative. Urine toxicity was positive.
Patient Data
An open wound is seen at the left upper aspect of the anterior abdomen. A laceration wound with a defect of the subcutaneous layer, anterior abdominal wall muscle and the peritoneal lining is seen at the right-sided abdomen.
Pneumoperitoneum is seen at the wound track, lining posterior to both rectus abdominis muscles and anterior to the liver and non-dependent area of the pelvis. Gas is observed along the falciform ligament. Minimal free fluid in the pelvis.
Mild hepatomegaly. Heterogenous hypodense areas are seen at segment IVb, likely focal fatty infiltration. A small linear laceration is seen at segment III of the liver, measuring 0.2 cm in maximum depth. No evidence of liver hematoma. There is no contrast extravasation to suggest an active bleed.
The gallbladder, spleen, pancreas and both adrenals are normal. Bilateral renal cysts with no complex features.
No bowel thickening to suggest hematoma or contusion. No abnormal bowel dilatation.
Case Discussion
This is a case of pneumoperitoneum, most likely related to the open wound of abdominal walls with liver injury grade 1. However, unable to exclude perforated viscus.
The patient underwent surgery. Intraoperative findings showed small puncture wounds at the left hypochondrium and right iliac fossa with a length of around 3 cm. These wounds were breaching the peritoneum. A small superficial liver laceration was noted with no active bleeding. Small and large bowel loops were grossly normal, with no evidence of perforation.
The patient recovered well and was under surgical clinic follow-up.
Pneumoperitoneum can caused by multiple factors, as described below.
perforated hollow viscus
postoperative intraperitoneal free air
peritoneal dialysis
pneumothorax
mechanical ventilation
open wound of abdominal wall breaching peritoneum.
However, the most common cause of pneumoperitoneum is perforated hollow viscus.
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