2019 Volume 39 Issue 6 Pages 1101-1104
An 83-year-old woman was transported by ambulance to a local hospital due to abdominal pain. Abdominal CT showed free gas in the peritoneal cavity. Since she was not considered to be seriously ill, she was followed-up without treatment. However, on the next day, follow-up CT revealed increased ascites；therefore, she was referred to our hospital for surgery. Blood tests showed no increase in inflammatory markers. An accurate medical history was difficult to obtain due to her dementia. However, because of the presence of abdominal pain, an exploratory laparotomy was performed with a diagnosis of gastrointestinal perforation. Laparotomy showed no contamination by ascitic fluid, and exploration of the stomach, small intestine, and colon failed to reveal any clear perforations of the gastrointestinal tract, leading to a diagnosis of spontaneous pneumoperitoneum. Surgery was completed with the placement of a drain in Douglas’ pouch. The patient’s postoperative course was uneventful, and she was discharged on the 9th postoperative day. We consider that in cases with few abdominal symptoms despite imaging evidence of free gas in the peritoneal cavity, indications for surgical treatment should be carefully determined with this disorder in mind.
