Abstract The finding of pneumoperitoneum on a chest radio-graph is most commonly associated with an underlying viscus perforation (Mularski et al. West J Med 170:41–46,1999). Urgent surgical intervention, in particular emergency laparot-omy, is often required in these cases. However, in 10 % of patients, a perforated viscus is not the precipitating cause of a pneumoperitoneum (referred to as a spontaneous or non-surgical pneumoperitoneum (SP). These cases are rarely asso-ciated with peritonitis and are usually managed conservatively (Mularski et al.West JMed 170:41–46,1999; Pitiakoudis et al. J Med Case Rep 5:86, 2011). We present a case of a 28-year-old female presented to the Accident and Emergency depart-ment with a 6-h history of severe abdominal pain and bilateral shoulder tip pain. She reported that the pain developed 2 h following sexual intercourse. She had undergone a laparoscop-ic total hysterectomy, bilateral saplingo oophorectomy and infra-colicomentectomy for borderlineovarian tumours 25days previ- ously. The most likely cause of this patient’sacute ab-dominal painwas a spontaneous pneumoperitoneumsecondary to sexual activity. Clinicians should be aware with the potential non-surgical causes for the presence of a pneumoperitoneum, particularly in patients who are not presenting with the other characteristic clinical features of an acute gastrointestinal perforation such as peritonitis, fever and elevated white cell
count. These particular patients can be largely managed conservatively.