Pneumoperitoneum is typically attributed to perforation of the gastrointestinal tract, which generally necessitates surgical management. Nonetheless, rare cases have been reported where spontaneous pneumoperitoneum occurs without perforated hollow viscus, originating from intrathoracic, intra-abdominal, gynecologic, or other miscellaneous sources. Among these instances, the occurrence of extensive subcutaneous emphysema (SE) in the context of pneumoperitoneum is particularly unusual, and current theories on the mechanisms by which air traverses the abdominal wall remains speculative. We present a case involving a 7-year-old boy who sustained pneumoperitoneum as a result of blunt chest trauma. Computed tomography revealed concomitant pneumothorax, pneumoperitoneum, and extensive SE. Although the pneumoperitoneum was induced by thoracic injury, we propose that the air did not traverse the diaphragm but instead emanated from the abdominal wall, as in subcutaneous emphysema.
Key words: Pneumoperitoneum, subcutaneous emphysema, CT scan
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