title: Recurrent spontaneous pneumoperitoneum: A surgical dilemma.
abstract: BACKGROUND
  Spontaneous pneumoperitoneum describes free air within the peritoneal cavity in the absence of iatrogenic causes or a perforated viscus. This report describes a rare case in which despite raised inflammatory markers, a trial of conservative management proved adequate.
  
  
  METHODS
  AM is a 36-year old woman who presented multiple times with abdominal pain and radiologically proven pneumoperitoneum. Her medical history included self catheterisation and cerebrovascular stenosis (Moyamoya disease), asymptomatic gallstones, livedo reticularis and peptic ulceration. On her index admission she exhibited raised inflammatory markers and fever. Despite these findings, emboldened by similar presentations in the past with no cause found, she declined surgical intervention with no untoward consequences.
  
  
  CONCLUSIONS
  Most patients presenting with non-surgically induced pneumpoeritoneum display signs of peritonism including pyrexia and raised inflammatory markers. For such patients, surgical intervention is usually required to find and rectify the cause.
  
  
  CONCLUSIONS
  A trial of conservative management may be appropriate in patients with spontaneous pneumoperitoneum but it must always be borne in mind that clinical deterioration represents an indication for surgical intervention.
authors.affiliation: Department of Surgery, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth PL6 8DH, United Kingdom.
authors.forename: Polly
authors.initials: P
authors.lastname: Estridge
authors.affiliation: Department of Surgery, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth PL6 8DH, United Kingdom. Electronic address: Jacob.akoh@nhs.net.
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Akoh
keywords: Conservative management; Inflammatory markers; Spontaneous pneumoperitoneum