Publication:

Conservative management of traumatic pneumoperitoneum in a 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.