Pneumoperitoneum is not always a serious finding, it is occasionally caused by benign conditions like pneumatosis coli. The absence of radiological signs of peritonitis like peritoneal fat blurring and free fluid should direct towards searching for benign causes of pneumoperitoneum. Communication with the physician and knowing more about the patient’s clinical status are also very important. This patient presented with acute abdominal pain of mild severity that is recurrent and his abdomen was lax. This clinical presentation is totally different in cases of bowel perforation or bowel ischemia.   

Pneumatosis coli is rare, idiopathic, and usually benign especially if the gas adopts bubbles (ie cystoides) rather than lines.  These gas cysts can rupture and cause repeated episodes of pneumoperitoneum without peritonitis as there is no spill of bowel content. 

The patient followed a conservative treatment with complete relief of symptoms within two days. Right hemicolectomy was advised.