A Case of Idiopathic Pneumoperitoneum Recurring Within About One Month

Abstract

The patient was a 67-year-old man with schizophrenia under long-term hospitalization at another hospital, who complained of abdominal discomfort. Abdominal CT revealed intra-abdominal free air, which raised the suspicion of gastrointestinal perforation, and the patient was referred to our hospital for further detailed examination and treatment. Physical examination was negative for signs of peritoneal irritation, and blood test results did not reveal an increased inflammatory response. Since difficulty in communicating with the patient hampered accurate pain assessment, an exploratory operation was performed for suspected gastrointestinal perforation. During the operation, the ascitic fluid did not appear to be contaminated, and no apparent perforation of the stomach, small intestine, or colon were identified. A drain was placed on the posterior aspect of the duodenum. The postoperative course was uneventful and the patient was discharged after 21 days. One month after being discharged, the patient vomited, was found to have intra-abdominal free air again on abdominal CT, and was referred to us. There were no abnormal findings, as was the case in the previous examination; the patient was diagnosed as having idiopathic pneumoperitoneum, which improved after conservative therapy. Our case is worth remembering as an example to demonstrate that surgery may be unnecessary in some patients who show intra-abdominal free air on CT when there are few other abnormal findings.