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Spontaneous pneumoperitoneum, often mistaken for a surgical emergency, can resolve with conservative management. This case shows non-surgical approaches are vital for patients with benign abdominal exams.

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Area of Science:

  • Gastroenterology
  • Abdominal Imaging
  • Surgical Oncology

Background:

  • Pneumoperitoneum typically indicates surgical complications or sepsis.
  • However, spontaneous pneumoperitoneum can arise from various non-perforative causes.
  • Identifying these cases avoids unnecessary urgent surgical intervention.

Observation:

  • A 72-year-old male with metastatic pancreatic cancer presented with abdominal distention.
  • Incidental massive pneumoperitoneum was found on imaging, with no evidence of perforation.
  • The patient's abdominal exam was non-peritonitic.

Findings:

  • Conservative management, including bowel rest, IV antibiotics, and hydration, was initiated.
  • The patient experienced a benign clinical course with preserved gastrointestinal function.
  • Pneumoperitoneum resolved completely on follow-up imaging two months post-discharge.

Implications:

  • This case underscores the need to consider non-surgical etiologies of pneumoperitoneum.
  • Conservative management is a viable option for selected patients with spontaneous pneumoperitoneum.
  • Appropriate patient selection can prevent unnecessary surgical interventions and improve outcomes.