Fatal Tension Pneumoperitoneum Due to Non-Accidental Trauma

A previously healthy two-year-old boy presented to the emergency department with vomiting. He was cyanotic with mottling of both lower extremities. He was in respiratory distress with retractions and diminished breath sounds. His abdomen was distended and rigid. He had a pulse of 170 beats per minute, blood pressure of 144/69mmHg and respiratory rate of 42 breaths per minute. He was endotracheally intubated. Chest and abdominal radiographs demonstrated a tension pneumoperitoneum (Figure 1). Abdominal decompression was performed with a 16-gauge Department of Emergency Medicine, University of Kansas Hospital, Kansas City, Kansas