Systemic lupus erythematosus presenting with pneumoperitoneum without evidence of pneumatosis cystoides intestinalis - when not to operate - a case report

Pneumoperitoneum in patients with systemic lupus erythematosus is commonly recognized as a surgical emergency that requires exploration. However, it may not be associated with bowel perforation and may be a benign disease manifestation. We present a case of a young patient who developed spontaneous pneumoperitoneum after pulse steroid therapy for lupus enteritis and was successfully managed conservatively. Patients with connective tissue disease may present with pneumoperitoneum, with or without pneumatosis cystoides intestinalis. Therefore, a detailed clinical history, thorough clinical examination, and laboratory parameters should be evaluated before proceeding with surgical intervention. A conservative approach may be attempted in patients with spontaneous pneumoperitoneum, and surgery should only be considered if clinical deterioration occurs.