Background:
Pneumoperitoneum is usually the result of visceral perforation requiring urgent surgical repair. In rarer cases, no perforation is found despite the present of free intra-peritoneal air. This is otherwise known as “spontaneous pneumoperitoneum”.
Case presentation:
We present a case of an 18-year old male who had upper abdominal pain but who otherwise was not peritonitic and had normal blood results. He was concerned about the cause of the pain as he had previously had an admission to a different hospital with similar symptoms. A chest x-ray revealed unexpected pneumoperitoneum. Subsequent imaging revealed no identifiable perforation and the patient was managed without proceeding to an emergency laparotomy.
Conclusion:
This case demonstrates the importance of considering an erect chest x-ray in patients presenting with upper abdominal pain, with otherwise normal parameters, to avoid missing rarer diagnoses. Furthermore it demonstrates how such cases of spontaneous pneumoperitoneum can be managed conservatively, avoiding unnecessary surgery.