HYBRID EVENT: You can participate in person at London, UK or Virtually from your home or work.

6th Edition of Global Conference on Surgery and Anaesthesia

September 15-17, 2025 | Hybrid Event

September 15 -17, 2025 | London, UK
GCSA 2025

A curious case of air without agony: Asymptomatic occult viscus perforation post fall

Malcolm Irem, Speaker at Surgery Conferences
Ealing Hospital, United Kingdom
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.

Biography:

Irem, following graduating from the university of Nottingham BMBS Course in 2024, is a Foundation Year 1 (FY1) doctor at Ealing Hospital, part of the London North West University Healthcare NHS Trust. Currently rotating through the Foundation Programme,he has gained experience in various specialties, including infectious diseases, general surgery and psychiatry. In their current role, he is working with the crisis team in psychiatry, providing acute mental health assessments and interventions to patients in urgent need of care.

Watsapp