{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T07:02:33Z","timestamp":1774940553011,"version":"3.50.1"},"reference-count":11,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Computed tomography (CT) plays a vital role in diagnosing suspected gastrointestinal perforation (GIP), particularly in the presence of pneumoperitoneum and intra-abdominal fluid. Nevertheless, these radiologic findings do not invariably correspond to bowel perforation, and negative surgical exploration may occur. We conducted this study to characterize the clinical features and outcomes of patients who underwent emergency surgery for suspected GIP but had no perforation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed consecutive non-trauma patients who underwent emergency surgical exploration during 2021\u20132025 for CT-confirmed pneumoperitoneum with fluid collection. Among 1,024 emergency surgical explorations (excluding appendectomies), 11 (1.1%) were classified as negative explorations, of which five cases without pneumoperitoneum were excluded, leaving six patients for analysis. We evaluated their clinical characteristics, laboratory findings, operative details, and 90-day outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The median age of the patients was 67.5 years [interquartile range (IQR): 58\u201377], and three patients (50%) were men. All patients presented with abdominal pain, with a median symptom duration of 84\u2005h (IQR: 72\u2013148). The median white blood cell count was 13.2\u2009\u00d7\u200910\n                      <jats:sup>9<\/jats:sup>\n                      \/L (IQR: 8.7\u201317.7), and the median C-reactive protein level was 23.6\u2005mg\/dL (IQR: 19.8\u201329.7). Final diagnoses included primary peritonitis (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091), sealed duodenal microperforation (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091), peritoneal abscess secondary to urinary tract infection (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092), severe oophoritis (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091), and soft tissue infection related to Fournier's gangrene (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091). The median intensive care unit (ICU) and hospital lengths of stay were 16 (IQR: 6\u201339) and 28.5 (IQR: 18\u201378) days, respectively. One patient died within 90 days (16%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pneumoperitoneum with fluid collection on CT does not invariably indicate bowel perforation. In clinically stable patients with prolonged symptoms, a brief period of careful observation and reassessment may be appropriate. These findings underscore the importance of integrating radiologic features with clinical judgment to guide surgical decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1739471","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T05:31:51Z","timestamp":1774935111000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Negative surgical exploration for CT-proven pneumoperitoneum: a diagnostic pitfall in suspected gastrointestinal perforation\u2014a six-case series"],"prefix":"10.3389","volume":"13","author":[{"given":"Min Chang","family":"Kang","sequence":"first","affiliation":[{"name":"Department of Critical Care Medicine, Uijeongbu Eulji Medical Center, Eulji University College of Medicine","place":["Uijeongbu, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hayeon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Uijeongbu Eulji Medical Center, Eulji University College of Medicine","place":["Uijeongbu, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haewon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Uijeongbu Eulji Medical Center, Eulji University College of Medicine","place":["Uijeongbu, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hak-Jae","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Uijeongbu Eulji Medical Center, Eulji University College of Medicine","place":["Uijeongbu, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyungwon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Uijeongbu Eulji Medical Center, Eulji University College of Medicine","place":["Uijeongbu, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nam-Ryong","family":"Choi","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Uijeongbu Eulji Medical Center, Eulji University College of Medicine","place":["Uijeongbu, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jay","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Uijeongbu Eulji Medical Center, Eulji University College of Medicine","place":["Uijeongbu, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eunhae","family":"Um","sequence":"additional","affiliation":[{"name":"Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine","place":["Goyang, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyunwoo","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Uijeongbu Eulji Medical Center, Eulji University College of Medicine","place":["Uijeongbu, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/j.mpsur.2008.01.004","article-title":"Acute abdomen: peritonitis","volume":"26","author":"Skipworth","year":"2008","journal-title":"Surgery (Oxford)"},{"key":"B2","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1177\/1457496920984078","article-title":"Secondary peritonitis and intra-abdominal sepsis: an increasingly global disease in search of better systemic therapies","volume":"110","author":"Clements","year":"2021","journal-title":"Scand J Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2638","DOI":"10.1097\/00003246-200007000-00078","article-title":"Pneumoperitoneum: a review of nonsurgical causes","volume":"28","author":"Mularski","year":"2000","journal-title":"Crit Care Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"435","DOI":"10.5152\/dir.2015.15066","article-title":"CT Findings in acute peritonitis: a pattern-based approach","volume":"21","author":"Filippone","year":"2015","journal-title":"Diagn Interv Radiol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"832","DOI":"10.21037\/atm-20-8158","article-title":"Negative surgical exploration in suspected gastrointestinal perforation: trend, preoperative predictors, and etiologies","volume":"9","author":"Liu","year":"2021","journal-title":"Ann Transl Med"},{"key":"B6","doi-asserted-by":"publisher","first-page":"106463","DOI":"10.1016\/j.ijscr.2021.106463","article-title":"Management of incidentally detected idiopathic pneumoperitoneum: a case report and literature review","volume":"87","author":"Sakaguchi","year":"2021","journal-title":"Int J Surg Case Rep"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4236\/oalib.1108612","article-title":"Non- surgical pneumoperitoneum: exceptional situation of multiple etiologies","volume":"9","author":"Mohamed","year":"2022","journal-title":"OALib"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e55687","DOI":"10.7759\/cureus.55687","article-title":"Navigating asymptomatic idiopathic pneumoperitoneum: a case report and a literature review","volume":"16","author":"Mahmoud Daoud","year":"2024","journal-title":"Cureus"},{"key":"B9","doi-asserted-by":"publisher","first-page":"101","DOI":"10.33590\/emjhepatol\/BWFU9578","article-title":"Secondary bacterial peritonitis due to an inadequately treated renal abscess","volume":"13","author":"Patel","year":"2025","journal-title":"EMJ Hepatol"},{"key":"B10","doi-asserted-by":"publisher","first-page":"110894","DOI":"10.1016\/j.injury.2023.110894","article-title":"Negative laparotomy rates and outcomes following blunt traumatic injury in the United States","volume":"54","author":"Atkins","year":"2023","journal-title":"Injury"},{"key":"B11","doi-asserted-by":"publisher","first-page":"5778","DOI":"10.1007\/s00464-024-11102-4","article-title":"Non-therapeutic laparotomies in military trauma (2009\u20132014)","volume":"38","author":"Walker","year":"2024","journal-title":"Surg Endosc"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1739471\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T05:31:51Z","timestamp":1774935111000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1739471\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,31]]},"references-count":11,"alternative-id":["10.3389\/fsurg.2026.1739471"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1739471","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,31]]},"article-number":"1739471"}}