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Background <p>Pneumoperitoneum is an uncommon condition characterized by free gas in the abdominal cavity, usually resulting from gastrointestinal (GI) tract perforation and requiring emergency surgery. Idiopathic pneumoperitoneum is a rare condition with no identifiable cause and might be managed conservatively in stable patients without peritonitis signs.</p> Case presentation <p>We report two cases of idiopathic pneumoperitoneum diagnosed by Computed tomography (CT) scan without obvious evidence of GI perforation. The etiology remains unclear, the more plausible explanation would be that increased intraluminal or intra-abdominal pressure induced by intestinal obstruction or constipation may contribute to occult micro perforation or mucosal disruption, which may not be detectable on contrast-enhanced CT imaging. The patients exhibited varied clinical presentations and responded well to conservative management, with complete clinical recovery.</p> Conclusions <p>This report aims to emphasize the diagnostic challenges in differentiating idiopathic pneumoperitoneum from surgically urgent causes of pneumoperitoneum and to advocate for an appropriate approach to conservative management in stable patients, even when CT imaging demonstrates free intraperitoneal gas.</p>

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Idiopathic pneumoperitoneum: two cases with possible association to elevated intraluminal pressure

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月24日

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  • Shuling Wang,
  • Xing Zhang,
  • Wei Li,
  • Jinlong Zhao,
  • Li He,
  • Ning Yang,
  • Qiwei Zhao,
  • Yang Wang,
  • Jianwei Ma,
  • Jian Zhang,
  • Yihao Song,
  • Fei Xu,
  • Zhongxin Li

摘要

Background

Pneumoperitoneum is an uncommon condition characterized by free gas in the abdominal cavity, usually resulting from gastrointestinal (GI) tract perforation and requiring emergency surgery. Idiopathic pneumoperitoneum is a rare condition with no identifiable cause and might be managed conservatively in stable patients without peritonitis signs.

Case presentation

We report two cases of idiopathic pneumoperitoneum diagnosed by Computed tomography (CT) scan without obvious evidence of GI perforation. The etiology remains unclear, the more plausible explanation would be that increased intraluminal or intra-abdominal pressure induced by intestinal obstruction or constipation may contribute to occult micro perforation or mucosal disruption, which may not be detectable on contrast-enhanced CT imaging. The patients exhibited varied clinical presentations and responded well to conservative management, with complete clinical recovery.

Conclusions

This report aims to emphasize the diagnostic challenges in differentiating idiopathic pneumoperitoneum from surgically urgent causes of pneumoperitoneum and to advocate for an appropriate approach to conservative management in stable patients, even when CT imaging demonstrates free intraperitoneal gas.