Pneumoperitoneum following perineal air insufflation can be managed conservatively

Introduction: Pneumoperitoneum is commonly associated with a perforated hollow viscus and often prompts emergency surgical intervention. However, not all cases necessitate operative management. A rare but important cause of pneumoperitoneum is air insufflation through the perianal route, which can lead to extensive subcutaneous emphysema and intra-abdominal free air without evidence of visceral perforation. Case description: We present a case of pneumoperitoneum following perianal air insufflation managed conservatively after a thorough clinical and radiological assessment revealed no indication for surgery. Conclusion: This case underscores the importance of distinguishing non-surgical from surgical pneumoperitoneum. Early recognition and appropriate conservative treatment can prevent unnecessary operative interventions and their associated risks. LEARNING POINTS: High-pressure air insufflation through the rectum is a rare but potentially severe form of trauma.This can lead to pneumoperitoneum that requires exploratory laparotomy in some cases.However, such traumatic pneumoperitoneum can be treated conservatively after excluding the presence of perforation.