Idiopathic Spontaneous Pneumoperitoneum: When Not to Operate

Abstract

Pneumoperitoneum is often a surgical emergency related to gastrointestinal tract perforation. On rare occasions, free intraperitoneal air can be present without any discernible cause and is considered Idiopathic Spontaneous Pneumoperitoneum (ISP). Deciding which patients with ISP can be managed conservatively would help prevent some patients from undergoing unnecessary surgery. We describe here two cases of successful management of ISP and the review of literature of ISP management for the past 29 years. In the first case, a patient with ISP with no significant abdominal symptoms was successfully managed non-operatively. In the second case, a patient with ISP and symptoms of small bowel obstruction was successfully treated surgically with exploratory laparotomy and small bowel resection. We recommend conservative management for the subset of ISP patients with no sign of peritonitis or sepsis.

Systemic lupus erythematosus presenting with pneumoperitoneum without evidence of pneumatosis cystoides intestinalis—when not to operate—a case report

“…However, not all pneumoperitoneum require surgical intervention. It has been observed that in some cases, surgeons may face challenges when it comes to accurately diagnosing and determining the appropriate treatment for patients who have spontaneous pneumoperitoneum and have performed exploratory laparotomies [ 15 , 16 ].…”

“…The patient’s history, clinical examination, and laboratory data should be correlated with the CT findings [ 17 ]. Patients with mild symptoms, benign findings on clinical examination, and no laboratory and imaging evidence of sepsis, bowel ischemia, or perforation can be diagnosed to have non-surgical or spontaneous pneumoperitoneum and can be managed conservatively [ 6 , 16 , 18 ]. Conservative treatment can be started with intravenous antibiotic therapy, nasogastric decompression, and bowel rest.…”