Pneumoperitoneum is not always an indication for laparotomy: A case report

Introduction: Pneumoperitoneum is a radiological term that is used to describe an abnormal collection of free gas in the peritoneal cavity but outside the viscera. In the majority of cases (>90%), it is a result of perforation of intra­ abdominal viscus with serious consequences and it needs for emergency surgical management. Pneumoperitoneum reflex to the surgeons to proceed to an exploration. Laparotomy and general anesthesia are associated with significant morbidity, therefore it is important to recognize idiopathic spontaneous pneumoperitoneum and treat it appropriately. Case Report: A case of 67­year­old male patient with a massive idiopathic spontaneous pneumoperitoneum that was operated without any cause of free air with a benign evolution during the postoperative period is reported. Conclusion: The absence of clear signs of peritonitis and sepsis allow the possibility to perform more studies as computed tomography scan and not to follow the suggestion of ‘any pneumoperitoneum require exploration’. Correct management of those cases can be treated conservatively avoiding unnecessary operations.