Spontaneous idiopathic recurrent pneumoperitoneum

Abstract

Pneumoperitoneum, gas under the diaphragm, is often a sign of significant intra-abdominal pathology, be it perforation in the stomach or duodenum secondary to peptic ulcer disease or in the small or large bowel as a result of inflammatory bowel diseases, diverticulitis or cancer, it can also be iatrogenic as a result of endoscopy or laparoscopy. The diagnosis is made with erect chest and abdominal radiographs, air is usually most visible under the right hemi-diaphragm. Here, we present a troublesome case of recurrent pneumoperitoneum, which despite extensive investigations and laparotomy no cause was found.

Figure 1:

Pneumoperitoneum visible under both hemi-diaphragms.

Figure 2:

Abdominal X-ray demonstrating Rigler's sign.

Figure 3:

Post laparotomy, nasogastric tube in situ.

Figure 4:

Recurrence of pneumoperitoneum.

Figure 5:

Horizontal view–air around liver.