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There is an increasing use of cryotherapy in the gastrointestinal tract for ablation of a variety of lesions. There is only a single reported case of perforation with spray cryotherapy, which was in a patient with Marfan syndrome. In this report, we describe pneumoperitoneum in a patient with a percutaneous endoscopic gastrostomy tube undergoing cryoablation. It is postulated that barotrauma at the percutaneous endoscopic gastrostomy site led to the pneumoperitoneum, and this can occur even with apparently adequate gas-venting procedures.