Conservatively Followed Spontaneous Pneumoperitoneum Reports of Two Cases

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 83; no. 11; pp. 1937 - 1942
• Main Authors: MORIWAKE, Kazuya, HAMAZAKI, Tomohiro, MIHARA, Daiki, TAKAHASHI, Tatsuya, KUISE, Takashi
• Format: Journal Article
• Language: Japanese; English
• Published: Japan Surgical Association 2022
• Subjects: conservative therapy; nonsurgical pneumoperitoneum; spontaneous pneumoperitoneum
• DOI: 10.3919/jjsa.83.1937
• ISSN: 1345-2843

In Case 1, a 70-year-old male patient had been on chemotherapy for advanced small cell lung cancer in our hospital. He was referred to our department because of pneumoperitoneum revealed on a chest X-ray. We started conservative therapy based on lack of any signs of peritonitis. As a result, the amount of pneumoperitoneum decreased, and he was discharged on the 9th hospital day. In Case 2, a 74-year-old female patient with multiple pulmonary nodules was referred to our department because of pneumoperitoneum detected on a chest computed tomography to follow the pulmonary nodules. She did not have any symptoms and the laboratory data were approximately normal. Therefore, we started follow-up at our outpatient clinic and terminated on the 46th hospital day when CT confirmed decreased pneumoperitoneum. Commonly, pneumoperitoneum is a sign of a viscus perforation, therefore emergent laparotomy is usually required. But spontaneous pneumoperitoneum, which is a rare condition defined intraperitoneal gas without obvious etiology, does not need laparotomy depending on the situation.