title: [Pneumoperitoneum: is exploratory laparotomy always indicated?].
abstract: Pneumoperitoneum usually indicates a surgical emergency because of visceral perforation in 85 to 95% of cases. Spontaneous pneumoperitoneum without peritonitis is a rare phenomenon which poses a dilemma for the surgeon who is faced with this problem. Some cases of pneumoperitoneum can and should be managed conservatively. We report three cases of pneumoperitoneum and describe their outcomes. Two cases were treated conservatively, and one underwent laparotomy but no perforated viscus was found. We review the aetiological mechanisms and the pathophysiology of the appearance of intra-abdominal free gas. Furthermore, a compilation of other aetiologies of pneumoperitoneum without peritonitis as reported in the literature is presented. Pneumoperitoneum, preceded by a reasonable clinical history in a patient with an adequate abdominal examination, may warrant continued observation, thus avoiding an unnecessary laparotomy.
authors.affiliation: Dipartimento di Chirurgia Generale e Vascolare, Clinica Sant'Elena, Quartu Sant'Elena, Cagliari.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Tuveri
authors.forename: Valentina
authors.initials: V
authors.lastname: Borsezio
authors.forename: Giorgia
authors.initials: G
authors.lastname: Melis
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Muntoni
authors.forename: Antonio
authors.initials: A
authors.lastname: Gabbas
authors.forename: Augusto
authors.initials: A
authors.lastname: Tuveri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000175:diagnosis; D011027:Pneumoperitoneum / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D016896:Treatment Outcome; D019564:Unnecessary Procedures