An unusual case of abdominal distension: pneumoperitoneum secondary to pneumomediastinum in a patient with chronic obstructive pulmonary disease.

A 68-year-old lady with end-stage chronic obstructive pulmonary disease presented with vomiting and abdominal pain. On examination her abdomen was grossly distended, diffusely tender and hyper-resonant. Imaging showed dilated loops of bowel and free air in the abdomen with no intestinal perforation. The free abdominal air had come down from the thorax by dissecting down around the oesophagus. A pneumomediastinum was present in her chest, secondary to her extensive emphysematous disease. She was treated conservatively and her pneumomediastinum resolved several weeks later, with subsequent resumption of intestinal motility and return to premorbid function. Surgical intervention would not have helped her condition.