Idiopathic pneumoperitoneum in a single case: an unusual entity

Abstract

Idiopathic pneumoperitoneum (IP) cases are rare and presents with varying symptoms, which makes propositions of standard treatments, clinically impracticable. There are limited IP therapies in the literature, necessitating a need, to continually highlight unique cases for the purpose of clinical education and training. This case describes an IP and management of a 34-year-old male who recently underwent a laparoscopic cholecystectomy. Patient presented to the emergency room with recurrent gastrointestinal (GI) symptoms. Despite two negative exploratory laparotomies without confirmatory evidence of GI perforations, the GI symptoms persisted, making it an unusual case. The surgeons elected to a multispecialty approach, detailing patient-specific symptoms, and corresponding treatments of the case. Based on the successful outcome of this patient, detailed knowledge of medical history, repeated physical assessments and patient-specific and comprehensive approach was shown to reduce unnecessary exploratory laparotomy, improved clinical outcomes and decrease in complications.

Keywords: Esophagogastroduodenoscopy; Exploratory laparotomy; Laparoscopic cholecystectomy; Nonsurgical pneumoperitoneum.

Figure 1

Free peritoneal air is likely related to recent LC.

Figure 2

Large amount of free intraperitoneal air is present.

Figure 3

Amount of pneumoperitoneum increased compared with previous CTs.

Figure 4

Similar appearance of moderate volume pneumoperitoneum compared with last CT.