A Case of Spontaneous Pneumoperitoneum Associated with Sigmoid Elongation

Abstract

The presence of intraperitoneal free gas is generally regarded as an important criterion for emergency surgery due to its association with gastrointestinal perforation. However, cases of spontaneous pneumoperitoneum with the appearance of intraperitoneal free gas despite the absence of clear signs of gastrointestinal perforation may occur, albeit rarely, and the cause may never be identified in some cases. The case of a patient with spontaneous pneumoperitoneum considered to be associated with the development of sigmoid elongation is reported along with a discussion of the literature.

An 84-year-old man presented with abdominal pain, and imaging showed signs of intraperitoneal free gas. Although signs of inflammation were mild, since symptoms of peritoneal irritation were present, gastrointestinal perforation was suspected, and emergency surgery was performed. However, no obvious site of perforation could be identified, and spontaneous pneumoperitoneum was diagnosed. Sigmoid elongation was also present, and since the colon was also significantly dilated, it was considered that intestinal wall dysfunction and elevated intra-intestinal pressure may have contributed to the development of spontaneous pneumoperitoneum.