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Peer-reviewedCC BY-NC-NDInternational journal of emergency medicine

Idiopathic pneumoperitoneum: two cases with possible association to elevated intraluminal pressure.

  • Shuling Wang1
  • Xing Zhang1
  • Wei Li1
  • Jinlong Zhao2
  • Li He3
  • Ning Yang1
  • Qiwei Zhao1
  • Yang Wang1
  • Jianwei Ma1
  • Jian Zhang1
  • Yihao Song1
  • Fei Xu4
1 more authors
  • Zhongxin Li5
5 affiliations
  1. 1Gastrointestinal Disease Diagnosis and Treatment Center, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
  2. 2Department of Gastroenterology and Surgery, The First Affiliated Hospital of Xingtai Medical College, Xingtai, Hebei, China.
  3. 3Department of Radiology and Nuclear Medicine, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China.
  4. 4Gastrointestinal Disease Diagnosis and Treatment Center, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China. [email protected].
  5. 5Gastrointestinal Disease Diagnosis and Treatment Center, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China. [email protected].
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Abstract

Background

Pneumoperitoneum is an uncommon condition characterized by free gas in the abdominal cavity, usually resulting from gastrointestinal (GI) tract perforation and requiring emergency surgery. Idiopathic pneumoperitoneum is a rare condition with no identifiable cause and might be managed conservatively in stable patients without peritonitis signs.Case presentation

We report two cases of idiopathic pneumoperitoneum diagnosed by Computed tomography (CT) scan without obvious evidence of GI perforation. The etiology remains unclear, the more plausible explanation would be that increased intraluminal or intra-abdominal pressure induced by intestinal obstruction or constipation may contribute to occult micro perforation or mucosal disruption, which may not be detectable on contrast-enhanced CT imaging. The patients exhibited varied clinical presentations and responded well to conservative management, with complete clinical recovery.Conclusions

This report aims to emphasize the diagnostic challenges in differentiating idiopathic pneumoperitoneum from surgically urgent causes of pneumoperitoneum and to advocate for an appropriate approach to conservative management in stable patients, even when CT imaging demonstrates free intraperitoneal gas.

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Cite

BibTeXRIS
BibTeX
@article{wang2026idiopathic,
  title = {{Idiopathic pneumoperitoneum: two cases with possible association to elevated intraluminal pressure.}},
  author = {Shuling Wang and Xing Zhang and Wei Li and Jinlong Zhao and Li He and Ning Yang and Qiwei Zhao and Yang Wang and Jianwei Ma and Jian Zhang and Yihao Song and Fei Xu and Zhongxin Li},
  journal = {International journal of emergency medicine},
  year = {2026},
  month = jul,
  doi = {10.1186/s12245-026-01309-8},
  url = {https://europepmc.org/article/MED/42907978},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Idiopathic pneumoperitoneum: two cases with possible association to elevated intraluminal pressure.
AU  - Shuling Wang
AU  - Xing Zhang
AU  - Wei Li
AU  - Jinlong Zhao
AU  - Li He
AU  - Ning Yang
AU  - Qiwei Zhao
AU  - Yang Wang
AU  - Jianwei Ma
AU  - Jian Zhang
AU  - Yihao Song
AU  - Fei Xu
AU  - Zhongxin Li
PY  - 2026
DA  - 2026/07/01
JO  - International journal of emergency medicine
DO  - 10.1186/s12245-026-01309-8
UR  - https://europepmc.org/article/MED/42907978
AB  - Background  Pneumoperitoneum is an uncommon condition characterized by free gas in the abdominal cavity, usually resulting from gastrointestinal (GI) tract perforation and requiring emergency surgery. Idiopathic pneumoperitoneum is a rare condition with no identifiable cause and might be managed conservatively in stable patients without peritonitis signs.Case presentation  We report two cases of idiopathic pneumoperitoneum diagnosed by Computed tomography (CT) scan without obvious evidence of GI perforation. The etiology remains unclear, the more plausible explanation would be that increased intraluminal or intra-abdominal pressure induced by intestinal obstruction or constipation may contribute to occult micro perforation or mucosal disruption, which may not be detectable on contrast-enhanced CT imaging. The patients exhibited varied clinical presentations and responded well to conservative management, with complete clinical recovery.Conclusions  This report aims to emphasize the diagnostic challenges in differentiating idiopathic pneumoperitoneum from surgically urgent causes of pneumoperitoneum and to advocate for an appropriate approach to conservative management in stable patients, even when CT imaging demonstrates free intraperitoneal gas.
SN  - 1865-1372
SN  - 1865-1380
ER  -