An unusual case of abdominal distension: pneumoperitoneum secondary to pneumomediastinum in a patient with chronic obstructive pulmonary disease.

A 68-year-old lady with end-stage chronic obstructive pulmonary disease presented with vomiting and abdominal pain. On examination her abdomen was grossly distended, diffusely tender and hyper-resonant. Imaging showed dilated loops of bowel and free air in the abdomen with no intestinal perforation.