# Laparoscopic Evaluation of Traumatic Pneumoperitoneum Without Hollow Viscus Injury: A Case Series

## TL;DR

This case series shows that diagnostic laparoscopy can safely avoid unnecessary surgery in trauma patients with pneumoperitoneum but no internal organ damage.

## Contribution

Demonstrates the utility of laparoscopy in evaluating traumatic pneumoperitoneum without hollow viscus injury in multiply injured patients.

## Key findings

- Three patients with traumatic pneumoperitoneum had no hollow viscus injury confirmed via laparoscopy.
- Diagnostic laparoscopy avoided unnecessary laparotomy in hemodynamically stable, multiply injured patients.
- High-energy trauma patients with thoracic injuries and fractures can benefit from this minimally invasive approach.

## Abstract

The presence of free pneumoperitoneum (free intraperitoneal air) after blunt trauma is generally considered indicative of a hollow viscus perforation, often necessitating emergency surgery. This finding presents a major diagnostic challenge in multiply injured patients. Here, we present three cases of traumatic pneumoperitoneum in multiply injured patients without visceral perforation. All patients had sustained high-energy trauma resulting in severe associated injuries, including thoracic trauma and multiple fractures. Diagnostic laparoscopy was utilized to evaluate the abdomen in each case and successfully ruled out intra-abdominal injuries, thus avoiding the morbidity of an unnecessary laparotomy. Our experience suggests that diagnostic laparoscopy can be a safe and effective tool for the evaluation of hemodynamically stable, multiply injured patients with traumatic pneumoperitoneum of an unclear etiology.