Abstract
Pneumoperitoneum indicates the need for urgent laparotomy. But under certain clinical situations like, patient on ventilatory support should arouse the suspicion of supradiaphragmatic source of pneumoperitoneum. Supradiaphragmatic causes account for 10%. This article describes two patients, both on ventilatory support in the intensive care unit. Failure to recognize spontaneous aseptic-pneumoperitoneum can result in unnecessary laparotomy with its risks. Hence under relevant circumstances, non-surgical causes of pneumopreitoneum should be excluded.