Tracheobronchial injury and pneumoperitoneum: case report and literature review

Background: The presence of a pneumoperitoneum associated with a tracheobronchial injury during a thoracic trauma poses a therapeutic problem as to the management of pneumoperitoneum. The objective is to discuss the contribution of a systematic abdominal exploration of the pneumoperitoneum in case of associated tracheobronchial wound. Case presentation: We report two cases of pneumoperitoneum associated with a tracheobronchial wound. One had a minimal pneumoperitoneum, and the other had a significant pneumoperitoneum. Tracheobronchial wounds were diagnosed by a chest CT and confirmed by bronchial fibroscopy. Because of the absence of signs of clinical abdominal severity, conservative treatment with thoracic drainage was performed without surgical explorers. Conclusions: For both patients, the outcome was favorable from a clinical, biological and radiological point of view. A bronchial fibroscopy was performed at one week, confirming the tracheobronchial healing. The advice of the thoracic surgeon should allow for a delay in systematic abdominal surgical exploration in case of pneumoperitoneum associated with tracheobronchial wound, subject to increased clinical-biological monitoring.