Benign Pneumoperitoneum: A Case Report and Literature Review.

Pneumoperitoneum is almost always considered as a warning sign of hollow visceral perforation and requires an urgent surgical review. However, free air within the peritoneal cavity does not always indicate a surgical emergency. In some cases, pneumoperitoneum can occur without true visceral perforation. Recognising this key difference is crucial to avoid unnecessary surgical intervention. A six-year-old girl with GNAO1-related neurodevelopmental disorder, epilepsy, movement disorder, on percutaneous endoscopic gastrostomy (PEG) tube feeds, and an implanted deep-brain stimulator presented with recurrent seizures, irritability, and reduced well-being. A computed tomography (CT) scan of the abdomen was suggestive of significant pneumoperitoneum, extensive colonic pneumatosis, and dilated bowel loops. Despite these radiological findings, the patient remained clinically stable, with normal vital signs, a soft and non-tender abdomen, no signs of peritonitis, and unremarkable inflammatory markers. The radiological imaging performed in this case contrasted with her clinical examination findings, which were quite reassuring for a benign pathology. Reports in the literature also describe similar cases with clinical presentations, where free intraperitoneal air arose from ruptured gas-filled cysts in the bowel wall rather than from actual perforation. Therefore, in patients who remain clinically stable, a cautious clinical approach with close monitoring and regular periodic reassessment is often more appropriate than immediate surgical intervention.