title: Conservative management of idiopathic pneumoperitoneum masquerading as peritonitis: report of a case.
abstract: Pneumoperitoneum is most commonly caused by the perforation of a hollow viscus, in which case an emergency laparotomy is indicated. We report herein the case of a patient who presented with the signs and symptoms of peritonitis, but who was found to have idiopathic pneumoperitoneum which was successfully managed by conservative treatment. A 70-year-old man presented with epigastric pain, nausea, and a severely distended and tympanitic abdomen. Abdominal examination revealed diffuse tenderness with guarding, but no rebound tenderness. He was febrile with leukocytosis and high C-reactive protein. Chest X-ray and abdominal computed tomography demonstrated a massive pneumoperitoneum without pneumothorax, pneumomediastinum, pneumoretroperitoneum, or subcutaneous emphysema, 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 in 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 present.
authors.affiliation: Department of Surgery, Niigata University School of Medicine, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Tani
authors.forename: Y
authors.initials: Y
authors.lastname: Shirai
authors.forename: M
authors.initials: M
authors.lastname: Sasagawa
authors.forename: T
authors.initials: T
authors.lastname: Wanifuchi
authors.forename: K
authors.initials: K
authors.lastname: Yagi
authors.forename: I
authors.initials: I
authors.lastname: Satoh
authors.forename: K
authors.initials: K
authors.lastname: Hatakeyama
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D010538:Peritonitis / Q000175:diagnosis*; D011027:Pneumoperitoneum / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D011859:Radiography