Case Report - Asymptomatic spontaneous pneumoperitoneum complicating duodenal diverticulum

A 91-year-old man was diagnosed with a spontaneous pneumoperitoneum. His abdomen was soft and flat and abdominal examination revealed no tenderness or rebound tenderness. Blood examination did not show signs of inflammation. A chest X-ray demonstrated a pneumoperitoneum without pneumothorax, or pneumomediastinum. Computed tomography showed intraperitoneal free air around the liver, without any other findings. Contrast examination and endoscopy of the upper gastrointestinal tract revealed a diverticulum of a horizontal portion of the duodenum. Spontaneous pneumoperitoneum was diagnosed as being of duodenal diverticulum origin. Conservative therapy including fasting and resuscitation was initiated. Disappearance of the intraperitoneal free air was confirmed 7 days after admission. He was in good health with no clinical evidence of recurrent disease after that. This conservative treatment should be the first choice for management in patients with pneumoperitoneum, in whom a perforated hollow viscus has been excluded by adequate examination.