Massive Pneumoperitoneum after Bronchoscopy and Noninvasive Ventilation in a COVID-19 Patient, without Associated Pneumomediastinum or Pneumothorax

The most common cause of pneumoperitoneum is a perforated hollow viscus. However, there are other causes that have been termed nonsurgical, asymptomatic, benign, or idiopathic pneumoperitoneum, most of them of thoracic origin; these are due to complications caused by invasive mechanical ventilation or interventional procedures such as fiberoptic bronchoscopy and are accompanied by pneumomediastinum, pneumothorax, or both. We present a case of isolated massive pneumoperitoneum, without accompanying pneumothorax or pneumomediastinum, in a patient with bilateral bronchopneumonia due to coronavirus disease 2019 (COVID-19) already cured and who underwent urgent bronchoscopy due to hemoptysis. This is a rather exceptional case due to barotrauma after noninvasive ventilation, and in whose pathophysiological mechanism both bronchoscopy and possible pulmonary fibrosis resulting from bilateral COVID-19 pneumonia may also have played a role.