Pneumoperitoneum: always a surgical case?

Spontaneous idiopathic pneumoperitoneum (SIP) is a rare condition in the surgical practice. We introduce a case of an alcoholic male who presented with nausea, vomiting and diarrhea without clinical signs of peritonitis. A computed tomography of the abdomen showed free air distributed mainly along the ascending colon. We performed an emergency laparoscopy, which revealed no signs of perforation or bowl ischemia but showed air bubbles in the mesentery along the ascending colon. Subsequent endoscopy revealed unclassified inflammatory bowel disease manifesting in the rectum, erythematous mucosa and epithelialized erosions of the stomach. The patient discharged himself on Day 8 after the surgery. The causes of SIP are unknown, but some authors assume microperforation. SIP can be a challenge for the choice of therapy. Laparoscopy may be particularly beneficial in patients with generalized peritonitis, while patients with moderate symptoms may benefit from conservative treatment.