An unusual case of nonsurgical pneumoperitoneum in a pediatric patient with burn injury: A case report

We present a rare case of a pediatric patient who was admitted with burns and was found to have spontaneous (non-surgical) pneumoperitoneum. Pneumoperitoneum is always considered an ominous radiological finding, necessitating emergent surgical exploration. However, around 5–15% cases can occur in the absence of visceral perforation, known as spontaneous or non-surgical pneumoperitoneum. We describe the case of a 5 year old boy admitted with 25% scald burn who developed nonspecific abdominal symptoms. Abdominal x-ray revealed presence of pneumoperitoneum, without any clinical manifestations of peritonitis. Computed tomography (CT) could not identify any site of perforation. The patient had transient hemodynamic disturbance requiring inotropes, but he soon improved with conservative approach and required minimal invasive procedure in the form of abdominal paracentesis. We stress the importance of effectively ruling out surgical causes before confirming the diagnosis of non-surgical pneumoperitoneum, and to be aware of this complication in pediatric burn patients. In the absence of symptoms and signs of peritonitis, conservative approach may be adopted in order to avoid unnecessary surgical interventions.