Spontaneous pneumoperitoneum associated with jejunal diverticulosis

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Abstract

Objective:

To report a case of pneumoperitoneum associated with jejunal diverticulosis.

Design:

Case report and review of the literature.

Patient:

An 80-year-old man presented with free air under the diaphragm, diagnosed on a routine chest X-ray. Clinical history revealed abdominal discomfort and weight loss during the previous year. There were no signs of peritonitis. Enteroclysis showed jejunal diverticulosis. Glucose/hydrogen breath test was pathological.

Intervention:

After antibiotic treatment, the patient improved, but the pneumoperitoneum persisted. Antibiotic treatment had to be stopped because of side effects. The patient remains well without further treatment.

Outcome:

Since 1956, 16 patients have been reported with pneumoperitoneum associated with jejunal diverticulosis without anatomical perforation. Bacterial gas production may be an important pathophysiological mechanism.

Conclusion:

When pneumoperitoneum without peritonitis is diagnosed, jejunal diverticulosis should be considered as a possible cause. Awareness of this condition may prevent unnecessary surgical intervention.

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