A Case of Repeated Idiopathic Pneumoperitoneum

Abstract

A 79-year-old man visited us complaining of constipation and abdominal fullness. While physical examination revealed no abnormal findings, a plain chest X-ray showed free air in the abdomen. Laboratory examination showed slight elevations of the serum C-reactive protein level and white blood cell count. Perforation of the gastrointestinal tract was suspected, and he was referred to a nearby hospital. At the hospital, abdominal computed tomography showed free air in the abdomen and multiple colonic diverticula. However, his symptoms and laboratory data did not suggest severe peritonitis. He received non-surgical management. An upper gastrointestinal series revealed diverticula and no perforation in the jejunum. A barium enema showed multiple diverticula and no perforations in the descending or sigmoid colon. His condition improved after resumption of diet. After 6 days of hospitalization, he was discharged. Approximately two months later, he exhibited the same symptoms again with free air on a plain X-ray of the chest. He again received conservative treatment, and his condition improved. Based on the clinical course, the diagnosis of repeated idiopathic pneumoperitoneum was established.