[Pneumoperitoneum without perforation of the digestive tract]

The authors present an account on 9 patients who were detected in their department during the nine-year period from 1991-2000 with the finding of pneumoperitoneum where perforation of the digestive tract was not proved. In 4 of them (44%) conservative treatment was used, in the remaining 5 patients (56%) the condition called for surgical revision. The latter was made as an acute operation in four patients because of signs of peritoneal irritation, in one only after 4 days because of suspected tumours intestinal disease. As to the site of the assumed source of the non-perforation pneumoperitoneum we included 6 of them into the group abdominal area, (1x pneumatosis cystoides intestinalis, 1x aerogenic infection from a perforated abscess of the right liver lobe, 2x microtraumas of the wall of the cardio-esophageal transition with massive vomiting, 1x microtraumas of the lesser curvature of the stomach during extreme distension of the stomach after incorrect intubation and resuscitation, 1x passage of gas through the inflamed distended colonic wall in colitis), two patients into the thoracic area (1x in conjunction with pneumothorax, 1x with hydrothorax), 1 patient in the urogenital area (by the gynaecological route after repeated coitus and orogenital practices). The authors summarize on the basis of data in the literature and their own experience diagnostic and therapeutic possibilities of this relatively rare finding.