Case Report
Volume 3 Issue 8 - 2020
Case Report of Negative Diagnostic Laparoscopy and EGD in a Patient with a Large Amount of Pneumoperitoneum
Jamesa Fabien, Yana Puckett* and Catherine Ronaghan
Department of Surgery, Texas Tech University Health Sciences Center, USA
*Corresponding Author: Yana Puckett, Department of Surgery, Texas Tech University Health Sciences Center, USA.
Received: May 09, 2020; Published: July 09, 2020


We present the case of a 23-year-old male who presented with epigastrium and left upper quadrant pain. A computerized tomography (CT) scan of his abdomen and pelvis revealed a moderate amount of intraperitoneal free air; however, upon diagnostic laparoscopy and esophagogastroduodenoscopy no abnormalities were found.

The incidence of free air in the peritoneum is termed pneumoperitoneum. This is normally a result of perforation in the abdominal cavity. However, there are some rare cases as in the case of our patient in whom pneumoperitoneum is not due to perforation. Such cases are known as non-surgical or spontaneous pneumoperitoneum. Non-surgical pneumoperitoneum has a variety of causes including thoracic, abdominal, iatrogenic, gynecological, and traumatic causes. It is likely that our patient was a case of pseudo-pneumoperitoneum or of true idiopathic pneumoperitoneum.

To investigate the most common diagnostic methods for this rare disease we searched the PubMed database with the search term ‘spontaneous pneumoperitoneum’. CT scan was seen to be the most commonly used diagnostic method. However, studies show that laparoscopy is more sensitive and more specific than CT when it comes to ruling out bowel perforation. Laparoscopy has also been proven to be a safer diagnostic method than laparotomy as the former poses less adverse effects.

In cases like that of our patient, we recommend the use of laparoscopy to rule out bowel perforation. Additionally, when there are no signs of peritonitis, fever is absent, and white blood cell count is normal, conservative management is highly recommended. By acquiring a working knowledge of the wide array of potential causes of pneumoperitoneum and their mechanisms, unnecessary surgical exploration and its associated morbidity can be avoided.

Keywords: Computerized Tomography (CT); Emergency Department (ED); Nonsteroidal Anti-Inflammatory Drugs (NSAIDS)


  1. M Richard., et al. “Pneumoperitoneum: A review of nonsurgical causes”. Critical Care Medicine 7 (2000): 2638-2644.
  2. D NMA Williams. "Spontaneous pneumoperitoneum and other nonsurgical causes of intraperitoneal free gas”. Postgraduate Medical Journal 73 (1997): 531-537.
  3. MTLM Eric Goldberg. Pneumatosis intestinalis” (2019).
  4. BSM Singh., et al. “Chilaiditi’s sign, a cause of pseudo-pneumoperitoneum: A case report”. AGE Open Medical Case Reports 6 (2018): 2050313X18812213.
  5. , et al. "Idiopathic Spontaneous Pneumoperitoneum-Avoiding Laparotomy-A Case Report”. The Ulster Medical Journal 65.1 (1996): 84-86.
  6. H Nagar and A Kessler. "Spontaneous Pneumoperitoneum in a Healthy Adolescent”. Journal of Pediatric Gastroenterology and Nutrition 2 (1999): 220-221.
  7. Joanna C Law-Courter., et al. "A case of spontaneous pneumoperitoneum”. The American Journal of Emergency Medicine3 (2005): 398-399.
  8. “Idiopathic spontaneous pneumoperitoneum”. Image in Medicine 57 (2011).
  9. Michail Pitiakoudis., et al. "Spontaneous idiopathic pneumoperitoneum presenting as an acute abdomen: a case report”. Journal of Medical Case Reports 5 (2011): PMC3052194.
  10. Tung-Lung Wu., et al. "Spontaneous pneumoperitoneum: Report of one case”. Journal of Acute Medicine1 (2013).
  11. Nidal İflazoğlu., et al. "Spontaneous idiopathic pneumoperitoneum with acute abdomen”. Turkish Journal of Surgery2 (2013): 110-112.
  12. Rahul Gupta., et al. "Pneumoperitoneum in the Newborn: Is Surgical Intervention Always Indicated?”. Journal of Neonatal Surgery 3 (2014).
  13. TW Ryo Tanaka., et al. "Conservative treatment of idiopathic spontaneous pneumoperitoneum in a bedridden patient: a case report”. Surgical Case Reports1 (2015): 69.
  14. Ippei Yamana., et al. "Spontaneous Pneumoperitoneum due to Constipation”. Case Reports in Gastroenterology3 (2015): 361-365.
  15. Ryan T Lewinson., et al. "Spontaneous pneumoperitoneum with subcutaneous emphysema”. BMJ Case Reports (2016).
  16. T Ueda., et al. “Spontaneous pneumoperitoneum with duodenal diverticulosis in an elderly patient: a case report”. Surgical Case Reports1 (2020): 3.
  17. , et al. "Massive Pneumoperitoneum Presenting as an Incidental Finding”. Cureus 10 (2018).
  18. Enda Hannan., et al. "The clinical dilemma of the persistent idiopathic pneumoperitoneum: A case report”. International Journal of Surgery Case Reports 63 (2019): 10-12.
  19. , et al. "Spontaneous idiopathic pneumoperitoneum: about a case”. The Pan African Medical Journal 35.76 (2020).
  20. MW Jones., et al. “Bowel Perforation”. Stat Pearls Publishing (2020).
  21. Sung Hwan Kim., et al. "Gastrointestinal Tract Perforation: MDCT Findings according to the Perforation Sites”. Korean Journal of Radiology 10 (2009): 63-70.
  22. Pietro Addeo., et al. "Diagnostic and therapeutic value of laparoscopy for small bowel blunt injuries: A case report”. International Journal of Surgery Case Reports8 (2011): 316-318.
  23. Zoe Freeman Weiss., et al. "Pneumomediastinum in marijuana users: a retrospective review of 14 cases”. BMJ Open Respiratory Research1 (2019): PMC6424304.
Citation: Yana Puckett., et al. “Case Report of Negative Diagnostic Laparoscopy and EGD in a Patient with a Large Amount of Pneumoperitoneum”. EC Clinical and Medical Case Reports 3.8 (2020): 07-12.

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