CONSERVATIVE MANAGEMENT OF IDIOPATHIC PNEUMOPERITONEUM MASQUERADING AS PERITONITIS - REPORT OF A CASE

Pneumoperitoneum is most commonly caused by the perforation of a hollo w viscus, in which case an emergency laparotomy is indicated. We repor t herein the case of a patient who,presented with the signs and sympto ms of peritonitis, but who was found to have idiopathic pneumoperitone um which was successfully managed by conservative treatment. A 70-year -old man presented with epigastric pain, nausea, and a severely disten ded and tympanitic abdomen. Abdominal examination revealed diffuse ten derness with guarding, but no rebound tenderness, He was febrile with leukocytosis and high C-reactive protein. Chest X-ray and abdominal co mputed tomography demonstrated a massive pneumoperitoneum without pneu mothorax, pneumomediastinum, pneumoretroperitoneum, or subcutaneous em physema, and subsequent examinations failed to demonstrate perforation of a hollow viscus. Thus, a diagnosis of idiopathic pneumoperitoneum was made, and the patient was managed conservatively, which resulted i n a successful outcome. This experience and a review of the literature suggest that idiopathic pneumoperitoneum is amenable to conservative management, even when the signs and symptoms of peritonitis are presen t.