# Navigating Asymptomatic Idiopathic Pneumoperitoneum: A Case Report and a Literature Review

## TL;DR

A case of asymptomatic pneumoperitoneum in a 65-year-old man highlights the possibility of spontaneous idiopathic pneumoperitoneum without organ perforation.

## Contribution

This case report adds to the literature on spontaneous idiopathic pneumoperitoneum in asymptomatic patients.

## Key findings

- A 65-year-old male presented with pneumoperitoneum but no signs of peritonitis or abdominal pain.
- Exploratory laparotomy revealed no perforation, supporting a diagnosis of spontaneous idiopathic pneumoperitoneum.
- The patient had an uneventful recovery, emphasizing the need to consider SIP in asymptomatic cases.

## Abstract

Pneumoperitoneum refers to the presence of free air in the abdominal cavity, typically indicating viscus perforation requiring urgent surgical intervention. Occasionally, pneumoperitoneum occurs without organ perforation, termed 'spontaneous’ or ‘non-surgical’ pneumoperitoneum. We present the case of a 65-year-old male referred to the emergency department after a seizure episode. The patient reported no abdominal pain or fever, and examination revealed no other signs of peritonitis. An erect chest X-ray showed air under the diaphragm, and a subsequent computed tomography (CT) scan confirmed free intraperitoneal air in the abdomen. The patient underwent a prompt exploratory laparotomy to assess for abdominal perforation, but the findings were negative. He had an uneventful post-operative hospital course and was discharged nine days after admission. This case underlines the importance of considering spontaneous idiopathic pneumoperitoneum (SIP) in asymptomatic patients and discusses management options.