Pneumoperitoneum is most commonly caused by hollow viscus perforation which requires an emergency surgical intervention. However, this is not always the case. Pneumoperitoneum which is not due to hollow viscus perforation is called Spontaneous or “non-surgical” pneumoperitoneum. Rarely, it can present with peritonitis but non-surgical pneumoperitoneum usually follows a benign course and can be managed conservatively. A case of 53-year-old male, non-smoker, non-alcoholic, hypertensive known to have decompensated chronic liver disease, since one year with portal hypertension and ascites was presented. The patient underwent uneventful laparoscopic cholecystectomy for acute calculous cholecystitis and developed spontaneous pneumoperitoneum due to intra-abdominal drain one week postprocedure. Pneumoperitoneum was successfully managed conservatively. A thorough history, physical examination and imaging are crucial in identifying patients with non-surgical pneumoperitoneum and to prevent unnecessary laparotomies. In present case, pneumoperitoneum was due to intra-abdominal drain which resolved after removing the drain. So, it is of utmost importance to rule out non-surgical causes of pnemoperitoneum, especially in surgeries where drain are kept in-situ.

Primary intestinal lymphangiectasia (PIL) is a rare protein-losing gastroenteropathy characterized by dilatation of the intestinal lymphatics and loss of lymph fluid into the gastrointestinal tract, leading to the development of hypoproteinaemia, oedema, lymphocytopenia, hypogammaglobinaemia, and immunologic abnormalities. We report a series of 4 children from Bangalore, India presenting with anasarca, diarrhoea, and hypoproteinaemia. All four patients were confirmed to have of PIL on histopathology. We retrospectively reviewed the case records of children diagnosed with primary intestinal lymphangiectasia presenting to department of pediatric gastroenterology within the time frame of July 2015 to September 2018. Four patients were diagnosed with primary intestinal lymphangiectasia. All of them presented with features of protein losing enteropathy (generalized oedema, ascites and low albumin), chronic diarrhoea, lymphopenia, hypercalcemia, and hypogammaglobulinemia. Endoscopically mucosa was normal in two patients and showed Snowflake appearance in other 2 patients. Intestinal biopsies were characteristic of lymphangiectasia in all four patients.