Conservative management of pneumoperitonitis after percutaneous transhepatic insertion of metallic biliary stents

The occurrence of pneumoperitoneum after a percutaneous transhepatic intervention is an exceptionally rare event. Generally it resolves spontaneously or with minimally invasive management even in symptomatic conditions (pneumoperitonitis); resorting to surgical approach is exceptional. What is still unclear is the question as to whether the airflow has an intestinal or atmospheric source. Our report lends support to the former hypothesis, as argued hereafter.