PMC4336396_01
Chest radiography July, 2011. Aseptic spontaneous pneumoperitoneum of unknown origin discovered during routine physical examination.
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In July 2011, this 66-year-old male presented to the emergency department with abdominal pain and distention following an outpatient chest radiograph revealing free intraperitoneal gas (Fig. 1).
Abdominal CT scan July 2011 confirming pneumoperitoneum.
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Physical examination on day two showed no new symptoms, however the computed tomography (CT) was positive for pneumatosis and pneumoperitoneum with undetermined source (Fig. 2).
Chest radiography completed March 2012 during emergency department work-up. Results determined free intraperitoneal gas.
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A chest radiograph was completed as part of the patient work-up and it revealed free air under the diaphragm (Fig. 3), similar to the previous episode six months earlier.
Abdominal CT March 2012. Confirming pneumoperitoneum and pneumatosis of small bowel.
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A repeat CT scan showed a large amount of free intraperitoneal gas with associated pneumatosis of the small bowel (Fig. 4).
Photograph taken during March 2012 laparotomy.
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Severe pneumatosis was present with no obvious perforation (Fig. 5).