Abstract
We report three cases of adult idiopathic pneumoperitoneum. All patients were incidentally found on a chest X-ray which demonstrated abdominal free air beneath the diaphragm during a routine examination. Computed tomography (CT) scans demonstrated intra-abdominal free air around the liver surface without any ascites. However, the physical abdominal examinations lacked any symptoms of peritonitis, such as Blumberg's sign or muscular defence, and the laboratory data were within normal limits. Nonsurgical managements were chosen and followed-up carefully, and resulted in successful outcomes.
Interestingly, pneumoperitneum recurred in case 2 and case 3. Especially in case 2, she received an exploratory laparotomy with a suspicion of gastrointestinal perforation 15 years previously, but perforated viscus was not detected and but only multiple jejunal diverticula were found. Idiopathic pneumoperitoneum itself is a rare condition, but this condition should be considered when encountering intra-abdominal free air without any symptoms or findings of peritonitis.
