Spontaneous Pneumoperitoneum Without Peritonitis

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FREE air in the abdominal cavity is almost always evidence of perforation of a hollow viscus as the consequence of serious organic disease. Surgical intervention is often required. In rare instances, spontaneous pneumoperitoneum may appear without peritonitis and may be managed expectantly; laparotomy is undesirable and unnecessary. This report concerns such a case associated with aerophagia.

Report of a Case

A 57-year-old woman was first examined at the Cleveland Clinic on January 22, 1965, because of severe intermittent abdominal pain for the preceding three months. For six years there had been episodes of abdominal distention, intestinal cramping, flatulence, constipation, and a restrosternal burning pain. Some relief of abdominal distention was obtained by belching or passing of flatus. Radiographic studies in 1960 were said to demonstrate a hiatus hernia and diverticula of the colon. On October 26, 1964, the patient underwent surgical repair of the hiatus hernia and obtained relief of the symptom of retrosternal burning. On the first postoperative day superficial thrombophlebitis of the right lower extremity developed, which responded to bed rest, elevation of the leg, and anticoagulants given orally. She was discharged from the hospital after 12 days, and did well at home except for intermittent episodes of cramping abdominal pain. On December 13, 1964, she was readmitted to the hospital because of severe colicky abdominal pain associated with pain in the left upper region of the chest and the shoulder. A roentgenogram of the abdomen demonstrated evidence of a large distended stomach and gas-filled large bowel and . . .



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