Big Five personality profiles, self-reported distress, and resilience resources among adults in Italy after the acute COVID-19 emergency: a cross-sectional cluster-analytic study.

Pneumoperitoneum, characterized by the presence of free intraperitoneal gas, is a clinical finding that classically signals a perforated abdominal viscus in an estimated 90% of cases []. This typically necessitates urgent surgical intervention. A rare but clinically relevant subset of patients can be classified as having “spontaneous” or “nonsurgical” pneumoperitoneum. This poses a diagnostic challenge, with free gas present without evidence of visceral perforation. This phenomenon has a diverse range of etiologies, including intrathoracic air dissection, in which air is commonly spread to the peritoneum intravascularly; gynecological entry via the fallopian tubes; or idiopathic causes, in which the gas is absorbed without sequelae. It is important that this subset of patients be recognized to avoid unnecessary invasive laparotomy procedures in patients who may be otherwise successfully managed conservatively. We present a case of pneumoperitoneum in the absence of perforation complicated by the presence of peritonitis. An 80-year-old man with a medical history significant for essential hypertension, chronic kidney disease stage 3a (estimated glomerular filtration rate 45-49 mL/minute), heart failure with reduced ejection fraction (stage D), paroxysmal atrial fibrillation, pulmonary hypertension, hyperlipidemia, and chronic urinary retention presented four days after cystoscopy with right retrograde pyelogram, bilateral ureteral stent exchange, and suprapubic catheter placement. He presented with diminished urine output, abdominal pain, and altered mental status. He had no history of immunocompromise, malignancy, chronic immunosuppressive therapy, or peritoneal dialysis. Computed tomography (CT) of the abdomen and pelvis demonstrated free intraperitoneal air concerning for perforated viscus, although no definite source of perforation was identified radiographically (Figure ).