SPONTANEOUS PNEUMOPERITONEUM AND OTHER NONSURGICAL CAUSES OF INTRAPERITONEAL FREE GAS

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.