Frontal chest X-ray. The air bubble below the right hemidiaphragm (on the left of the image) is a pneumoperitoneum.
Classification and external resources
Specialty gastroenterology
ICD-10 K66.8
ICD-9-CM 568.89, 770.2
DiseasesDB 31511
eMedicine radio/562
MeSH D011027
Another pneumoperitoneum on chest X-ray.
Pneumoperitoneum seen on X-ray with the patient lying on his left side.

Pneumoperitoneum is pneumatosis (abnormal presence of air or other gas) in the peritoneal cavity, a potential space within the abdominal cavity. When present, it can often be seen on radiography, but small amounts are often missed, and CT scan is nowadays regarded as a criterion standard in the assessment of a pneumoperitoneum.[1] CT can visualize quantities as small as 5 cm³ of air or gas. The most common cause is a perforated abdominal viscus, generally a perforated peptic ulcer, although any part of the bowel may perforate from a benign ulcer, tumor or abdominal trauma. A perforated appendix seldom causes a pneumoperitoneum.

In the mid-twentieth century, an "artificial" pneumoperitoneum was sometimes intentionally administered as a treatment for a hiatal hernia. This was achieved by insufflating the abdomen with carbon dioxide. The practice is currently used by surgical teams in order to perform laparoscopic surgery.


Differential diagnosis

Subphrenic abscess, bowel interposed between diaphragm and liver (Chilaiditi syndrome), and linear atelectasis at the base of the lungs can simulate free air under the diaphragm on a chest X-ray.


Pneumoperitoneum can be described as peritoneal emphysema,[4] just as pneumomediastinum can be called mediastinal emphysema, but pneumoperitoneum is the usual name.

See also


  1. Ali Nawaz Khan. " Pneumoperitoneum".
  2. Necrotizing Enterocolitis Bugs, Drugs and Things That Go Bump in the Night
  3. Sexual Activity as Cause for Non-Surgical Pneumoperitoneum
  4. Marian, K; et al. (2015), "Spontaneous pneumoperitoneum in a patient after ventilation therapy", Pol Przegl Chir, 86 (12): 601–603, doi:10.1515/pjs-2015-0008, PMID 25803061.
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