Abstract

Introduction: Pneumoperitoneum can have many causes (thoracic, abdominal, gynaecological, iatrogenic) or sometimes can be idiopathic. In most of the cases it is associated with perforation of hollow viscera and usually requires an urgent surgical intervention. In rare cases, pneumoperitoneum might be non-surgical (there is no visceral perforation and no surgical treatment is required).

Case report: We present a case report about spontaneous pneumoperitoneum after fibro esophagogastroduodenoscopy (FEGDS). An 88-yearold woman was hospitalized to the Intensive Care Unit because of hypovolemic shock due to severe gastrointestinal bleeding. FEGDS was performed and the bleeding was stopped. Next day the patient was suspected to have pneumonia and chest x-ray was done. The X-ray has revealed free air in peritoneal cavity. Although, there were no signs of peritonitis, an urgent laparotomy was done. However, during the surgery no cause of pneumoperitoneum was found.

Conclusion: It is very important to know a comprehensive patient‘s illness history, to do thorough physical examination, appropriate laboratory tests and radiologic examination to identify patients with non-surgical pneumoperitoneum and avoid unnecessary operation.

Keywords: Pneumoperitoneum; Non-surgical pneumoperitoneum; Idiopathic spontaneous pneumoperitoneum; Fibroesophagogastroduodenoscopy; Surgery

Core Tips

Pneumoperitoneum might be surgical and non-surgical. It is very important to comprehensively evaluate the clinical situation to avoid unnecessary operation. We report a case about spontaneous pneumoperitoneum after FEGDS. During the surgery no cause of pneumoperitoneum was found. Appealing to our experience and analysis of the literature, we claim that free air in peritoneal cavity after endoscopic procedure is a very rare case. We consider that in ambiguous clinical situations laparoscopic surgery could be a standard procedure to diagnose the aetiology of pneumoperitoneum, and to perform treatment manipulations.