Pneumoperitoneum in dis-eases and traumas of the upper part of the digestive tract -  an overview of current knowledge and clinical context.

Pneumoperitoneum is a clinically significant and dia-gnostically important finding that most commonly indicates perforation of a hol-low organ within the gastrointestinal tract. Within the upper gastrointestinal tract, the most frequent cause of pneumoperitoneum is gastroduodenal perforation. However, less common etiologies must also be considered, including perforation of the distal esophagus, gallbladder, or bile ducts resulting from inflammatory dis-ease, trauma, or iatrogenic injury. Dia-gnosis is based on a combination of clinical assessment, imaging modalities, and supportive laboratory parameters. Plain abdominal radiography has limited sensitivity in detecting small amounts of free intraperitoneal gas; therefore, contrast-enhanced computed tomography is currently considered the dia-gnostic standard. Management of free gastrointestinal perforation is primarily surgical, whereas selected forms of pneumoperitoneum may be treated conservatively or endoscopically. The choice of surgical procedure depends on the affected organ, intraoperative findings, and the patient's overall clinical condition. Early recognition of the condition is essential for improving clinical outcomes and reducing patient morbidity and mortality.