Pneumoperitoneum as a complication of barotrauma is a rare condition due to mechanical ventilation. The diagnostic dilemma often leads to perform an exploratory laparotomy, with the suspect of perforation of a hollow viscus, that makes worse the prognosis of these patients. We describe three patients who developed pneumoperitoneum, secondary to barotrauma. In the last one the use of laparoscopy allowed us to avoid an useless laparotomy.
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