Pneumo-peritoneum following PEG insertion: a clinical dilemma

We present the case of a 48 year old male with multiple sclerosis who later became unwell with fever and vague abdominal pain 2 days after inserting a percutanous endoscopic gastrostomy (PEG) tube. His chest x-ray showed gas under the diaphragm. As a result of this, a laparotomy was performed which found no evidence of intra-abdominal sepsis. We discuss the importance of recognising 'benign' pneumoperitoneum following PEG insertion. Further imaging, such as abdominal CT scan is desirable prior to consideration of laparotomy when diagnostic uncertainty exists.