Recurrent Non-surgical Pneumoperitoneum Associated With Jejunal Diverticulosis: A Case Report and Diagnostic Challenge.

Spontaneous pneumoperitoneum presents a significant diagnostic challenge because the radiological presence of free intraperitoneal gas conventionally prompts urgent clinical assessment for suspected viscus perforation. Jejunal diverticulosis is an infrequent but documented etiology of recurrent, non-surgical free air that can masquerade as a surgical emergency. A 69-year-old female patient with a three-year history of recurrent pneumoperitoneum and documented jejunal diverticulosis presented with abdominal pain and low-grade fever. Clinical examination revealed mild abdominal distension without evidence of peritonitis. Laboratory investigations identified elevated C-reactive protein alongside severe hypothyroidism, while the white blood cell count remained within normal physiological limits. Although initial computed tomography (CT) demonstrated massive free air, subsequent oral contrast CT provided additional evidence against an active perforation, supporting conservative management when interpreted alongside the patient's stable clinical examination. Rapid clinical resolution was achieved, and the patient remained asymptomatic throughout the follow-up period. Recognizing jejunal diverticulosis as a potential cause of benign pneumoperitoneum is essential to avoid unnecessary surgical morbidity. A tailored approach, prioritizing clinical stability and nuanced imaging interpretation, is necessary to manage such cases effectively.