BACKGROUND Air in the peritoneal cavity is called as Pneumoperitoneum. Not all the cases of pneumoperitoneum are due to hollow viscus perforation. Most common cause of pneumoperitoneum is due to hollow viscus perforation in 90% cases, mostly due to duodenal ulcer perforation or gastric perforation. In 10% of the cases, the pneumoperitoneum does not indicate the perforation nor warranted the surgery. Pneumoperitoneum that is non-iatrogenic that does not need surgery is called as spontaneous pneumoperitoneum. MATERIALS AND METHODS This study analyses the spontaneous/non-surgical causes of pneumoperitoneum and our experience in our institute for the past 5 years that is from June 2011 to May 2016 and also aims to create awareness about the non-surgical causes of pneumoperitoneum, identifying cases for which negative laparotomy can be avoided. RESULTS In this period 11 patients were identified with nonsurgical causes of pneumoperitoneum, from that 2 patients underwent emergency laparotomy which was negative and 9 patients were managed conservatively. CONCLUSION In our study totally 11 patients were presented with pneumoperitoneum, out of which 9 patients were managed conservatively and 2 patients underwent negative laparotomy. Most common cause of spontaneous pneumoperitoneum in our study is thoracic cause.

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