Idiopathic pneumoperitoneum presenting as acute abdomen

34 year old male, presented to Emergency department with abdominal pain ,multiple episodes of non bilious vomiting and fever for 1 day duration, not passed flatus and stool since 2 days , history was unremarkable with no history of any Nonsteroidal anti-inflammatory medication intake , peptic ulcer disease, any operative procedure/ endoscopic procedures in the past .No history of Tuberculosis, Trauma, any past medical illness/admission, vital data:BP:106/60 PR:110/min, Respiratory rate: 20/min ,afebrile On examination distended ,umbilicus inverted central , diffuse abdominal tenderness, guarding and rigidity present , bowel sounds were absent.