Not All Free Air Needs a Scalpel: A Case of Spontaneous Pneumoperitoneum in a Patient With Asthma.

Pneumoperitoneum typically suggests gastrointestinal perforation requiring urgent surgery. However, in rare cases, it occurs without intra-abdominal pathology. We present a case of a 55-year-old male with asthma who developed spontaneous pneumoperitoneum. He presented with respiratory symptoms and mild abdominal discomfort; imaging revealed free intraperitoneal air. With a benign abdominal exam and clinical stability, he was managed conservatively. This case emphasizes distinguishing surgical from non-surgical pneumoperitoneum to avoid unnecessary operations, particularly in patients with pulmonary conditions. Clinicians should maintain awareness of non-surgical and intrathoracic causes to ensure accurate diagnosis and appropriate care.