The Clinical Dilemma of the Persistent Idiopathic Pneumoperi
Idiopathic pneumoperitoneum (IP) is a rare phenomenon which merits special attention. It is defined as free intraperitoneal air which is not caused by viscus perforation and does not require surgical intervention. It is generally considered a diagnosis of exclusion and often poses a genuine diagnostic dilemma.

This is an exceedingly rare case of persistent IP in a 71-year-old patient which was found incidentally on a thoracic CT scan during investigation of chronic cough that has persisted on serial radiology. This case is unique as it demonstrated a persistent pneumoperitoneum at 4 month interval which was managed conservatively successfully.

A 71-year-old Caucasian male presented to the emergency department with productive cough and dyspnoea on a background of recurrent lower respiratory tract infections (LRTI). His chest radiograph demonstrated no gross abnormality. He was initially treated as a presumed LRTI with intravenous antibiotics. A CT thorax demonstrated multiple pockets of sub-diaphragmatic intraperitoneal free air just anterior to the liver and close to the gastric antrum, raising concern for gastric perforation.

Source: International journal of surgery case reports

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