Abstract
An 80-year-old man was transferred to our emergency clinic because of discomfort with cold sweat while waiting at the pharmacy. He hardly showed any subjective symptoms such as spontaneous abdominal pain or tenderness at the time of emergency conveyance, though he felt nauseated when the ambulance service had arrived at the pharmacy. Hematological tests did not reveal elevated inflammatory reaction or other abnormal findings. However, abdominal computed tomography showed presence of free air around the spleen and the bowel in the abdominal cavity; therefore, he was referred to the surgery department under the suspicion of gastrointestinal perforation. He was admitted and was administered conservative treatment for idiopathic pneumoperitoneum. The patient refused colonoscopy; therefore, upper gastrointestinal endoscopy was performed, but no perforation was detected. On the sixth day, his abdominal symptoms had resolved and hematological data was normal; further, abdominal computed tomography revealed no free air after oral intake was resumed. He was discharged from our hospital after 14 days.
Care should be taken when considering surgical intervention in cases in which idiopathic pneumoperitoneum is suspected, especially when symptoms and laboratory data hardly suggest severe peritonitis in spite of imaging studies showing presence of free air in the abdominal cavity.
