The presentation of two rare idiopathic diseases in one patient: spontaneous idiopathic pneumoperitoneum and idiopathic gastroparesis: a case report

Abstract

Introduction: Idiopathic gastroparesis (GP) is a syndrome characterized by delayed gastric emptying in the absence of a mechanical obstruction and the presence of cardinal symptoms, spontaneous idiopathic pneumoperitoneum is the presence of free air in the abdomen with the exclusion of a perforated viscera on endoscopy; both diseases have a low prevalence in which no detectable primary etiology can be identified. The authors present the case of a 44-year-old female with both diseases occurring simultaneously. Presentation of case: A 44-year-old female without relevant prior medical history, presented to the emergency room with intense abdominal pain in all four quadrants, on superficial and deep palpation. Imaging studies were conducted revealing the presence of a distended stomach filled with contrast and free air in the abdomen. An endoscopy was conducted looking for an obstruction of the gastric content and a laparotomy for the presence of a perforation on the viscera; both were ruled out. Clinical discussion: Although surgical intervention is not necessary on a patient presenting either with GP or spontaneous idiopathic pneumoperitoneum, given the clinical presentation and image studies of this patient with the finding of free air in the abdomen, a distended stomach filled with contrast and severe abdominal pain, it was decided to perform a laparotomy looking for a possible source and avoid complications of a possible blockage and/or perforation in the gastrointestinal tract. Conclusion: First-time cases pose a challenge for physicians at the moment of deciding on the best treatment option for the patient, especially with low-frequency pathologies.