TITLE:
A Rare Cause of Pneumoperitoneum after Drowning: Gastric Laceration Following Seawater Submersion
AUTHORS:
Anass Saile, Badre Mouhaoui, Badria Aggoug, Salma Falahi, Mohammed Anass Fehdi, Asmaa Dafir, Mohammed Mouhaoui
KEYWORDS:
Seawater Drowning, Pneumoperitoneum, Gastric Perforation, ARDS, Pneumomediastinum, Intensive Care
JOURNAL NAME:
Open Journal of Emergency Medicine,
Vol.14 No.4,
October
21,
2026
ABSTRACT: Drowning is a public health problem responsible for substantial morbidity and mortality worldwide, particularly among adolescents. We report the case of a 15-year-old male admitted to our trauma center after a witnessed seawater submersion lasting approximately 10 minutes. On admission, he was obtunded and hypothermic, with respiratory instability and marked abdominal distension. Rapid neurological and respiratory deterioration required emergency orotracheal intubation. Whole-body computed tomography showed bilateral ground-glass opacities consistent with aspiration-related lung injury, peri-esophageal pneumomediastinum, and a large-volume compressive pneumoperitoneum. Emergency exploratory laparotomy identified a 4 cm full-thickness laceration of the lesser gastric curvature, which was repaired primarily with omentoplasty and subhepatic drainage. The postoperative course was favorable, with successful extubation and complete neurological recovery. The mechanism of the gastric injury could not be established with certainty; acute gastric overdistension is the most plausible explanation, since marked abdominal distension was already present before mechanical ventilation was instituted. This case illustrates a rare but life-threatening abdominal complication of seawater drowning and the importance of distinguishing surgical from non-surgical pneumoperitoneum in this setting.