Spontaneous pneumoperitoneum: diagnostic and management difficulties

Caroline M Mann, Chandra S Bhati, David Gemmell, Peter Doyle, Vibhore Gupta, David F Gorman
Emergency Medicine Australasia: EMA 2010, 22 (6): 568-70
Acute abdominal pain is a common presentation to the ED. Most patients undergo a chest radiograph as part of their initial investigations, which occasionally reveals pneumoperitoneum. Pneumoperitoneum on imaging suggests a perforated hollow abdominal viscus and therefore often constitutes a surgical emergency. However, if the patient is neither peritonitic nor septic a management dilemma is faced. Some cases of pneumoperitoneum might be managed conservatively thus avoiding unnecessary laparotomy. We present a case of recurrent spontaneous pneumoperitoneum with abdominal pain that was managed conservatively and discuss the possible aetiologies and management issues of spontaneous pneumoperitoneum.

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