Title : A curious case of air without agony: Asymptomatic occult viscus perforation post fall
Abstract:
Aims: To highlight the diagnostic and therapeutic challenges of asymptomatic pneumoperitoneum in elderly patients and to demonstrate that conservative, non-operative management can be a safe and effective approach in the absence of clinical deterioration or peritonitis.
Methods: We conducted a detailed review of a 103-year-old male patient who presented following a mechanical fall. Clinical assessment, laboratory testing, and full-body trauma protocol CT imaging were undertaken. Multidisciplinary discussions guided the management approach, with emphasis on clinical monitoring in lieu of surgical intervention, given the absence of abdominal symptoms and stable vital parameters.
Results: CT imaging revealed free intraperitoneal gas without an identifiable perforation site. The patient remained haemodynamically stable and entirely asymptomatic throughout admission. Conservative treatment including bowel rest, intravenous fluids, antibiotics and close observation was successful. No surgical intervention was required and the patient was safely discharged following an uneventful recovery.
Conclusion: This case supports the growing evidence that non-operative management may be appropriate for selected elderly patients with radiological evidence of pneumoperitoneum but no clinical signs of peritonitis. It underscores the importance of integrating clinical judgment with imaging findings to optimise outcomes.
Key Statements: Asymptomatic pneumoperitoneum in elderly patients can represent a sealed or self-limited viscus perforation. CT imaging, while sensitive, may not always localise the perforation site. Conservative management, comprising of bowel rest, antibiotics, and observation, can be both safe and effective in stable patients. This case reinforces the importance of clinical context in guiding treatment decisions and highlights that elderly patients may present atypically despite significant pathology.
