Idiopathic benign pneumoperitoneum: a case series

Pneumoperitoneum is most commonly associated with hollow viscus perforation and represents a surgical emergency. However, a subset of cases, termed benign pneumoperitoneum, occur without visceral perforation and can often be managed conservatively. Idiopathic cases remain particularly rare, with few reports in the literature. We present a retrospective case series of three patients from three tertiary care hospitals with idiopathic benign pneumoperitoneum. All patients were hemodynamically stable at presentation, with imaging demonstrating intraperitoneal free air and no clinical signs of sepsis. Management strategies included laparotomy in one patient, laparoscopy in another, and observation in the third. This series adds to the limited reports on idiopathic benign pneumoperitoneum and supports conservative management in carefully selected patients, while acknowledging the difficulties with clinical decision making. Awareness of this rare entity may help avoid unnecessary operative intervention. Serial clinical assessment and close observation are important considerations in management of this unique patient population.