Nma. Williams et Dfl. Watkin, SPONTANEOUS PNEUMOPERITONEUM AND OTHER NONSURGICAL CAUSES OF INTRAPERITONEAL FREE GAS, Postgraduate medical journal, 73(863), 1997, pp. 531-537
Intraperitoneal free gas seen radiologically as air under the diaphrag
m nearly always indicates a perforated abdominal viscus that requires
surgical intervention. Rarely, however, the presence of a pneumoperito
neum may not indicate an intra-abdominal perforation and thus may not
require laparotomy. Such a situation is termed spontaneous or nonsurgi
cal pneumoperitoneum. In this review, we explore the aetiological mech
anisms and the pathophysiology of the appearance of intra-abdominal fr
ee gas. An appreciation of the condition and its likely aetiological f
actors should improve awareness and possibly reduce the imperative to
perform an emergency laparotomy on an otherwise well patient with an u
nexplained pneumoperitoneum.