Pneumoperitoneum usually is synonymous to perforation of hollow viscus and in an ordinary presented as a frank peritonitis. However, about 10% of patients may presented with an unusual cause of pneumoperitoneum, without obvious sign and symptoms related to this event, so called spontaneous pneumoperitoneum. Spontaneous pneumoperitoneum may pose a diagnostic dilemma, especially when an evaluating patient has no or minimal abdominal findings. Conservative, non surgical treatment should be considered in those patients with pneumoperitoneum if perforation of hollow viscus have been excluded. We believe that this case report may help to selected of patients who can be treated without operation, thus diminishing a negative diagnostic laparotomy.
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