Purpose Pneumoperitoneum is mainly associated with perforated abdominal viscus. However, some cases do not involve perforation and do not require surgical intervention, and thus, benign pneumoperitoneum is diagnosed. In rare cases, urological causes can be related to benign pneumoperitoneum. We present a case of benign pneumoperitoneum related with urolithiasis, an association never reported before. Presentation of case We report the case of a 53-year-old male who presented to the emergency department due to a renal colic. Laboratory tests were not suggestive of any infectious or inflammatory processes. Imaging studies revealed a ureteral stone and an incidental finding of pneumoperitoneum not related to viscus perforation. A surgical procedure was indicated for urolithiasis, and several causes of pneumoperitoneum were ruled out. Follow-up studies showed spontaneous pneumoperitoneum regression, and the patient remained asymptomatic. However, the precise cause of the pneumoperitoneum remains unclear. Discussion To our knowledge, this is the first case reported of benign pneumoperitoneum associated with urolithiasis. It is important to highlight that this condition could be managed without surgical intervention after general surgery consultation is obtained. An extensive history and physical examination support the dismissal of bowel perforation as the etiology of pneumoperitoneum. Conclusions Benign pneumoperitoneum remains a diagnostic and therapeutic challenge that, in all cases, requires general surgery consultation to determine the likelihood of bowel perforation and establish an appropriate management for each patient, especially in the decision making of the pertinence of surgical intervention.