Pneumoperitoneum refers to the presence of air in the abdomen outside of the gastrointestinal tract. This occurs in the setting of an intestinal perforation, which can be iatrogenic (eg, due to surgical enterotomy), as the benign result of laparoscopic surgical technique, or as a sequela of bowel perforation due to underlying ischemia, ulceration, infection, or trauma (including post-resuscitation). A cause or association of pneumoperitoneum is intestinal air (pneumatosis intestinalis).

Patients with pneumoperitoneum from bowel perforation can present with a range of symptoms from localized abdominal pain to severe abdominal pain with rebound and guarding. This can be a life-threatening surgical emergency associated with end-organ dysfunction due to septic shock.

Management of pneumoperitoneum depends on the underlying etiology and the patient's condition. Treatment can include supportive observation, antibiotics, or emergent surgery with repair of luminal defect.