Recurrent benign pneumoperitoneum: pneumatosis coli
Recurrent episodes of spontaneous pneumoperitoneum. Nil found at surgery apart from an unusual hepatic flexure.
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Free intra-peritoneal gas with extensive gas bubbles in the wall of the hepatic flexure (sitting between the right hemidiaphragm and liver)
Pneumatosis coli is rare, idiopathic and usually benign especially if the gas adopts bubbles (ie cystoides) rather than lines. These gas cysts can rupture and cause repeated episodes of pneumoperitoneum without peritonitis as there is no spill of bowel content. In this case the surgeon eventually resected the right colon to prevent further episodes.