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Pneumoperitoneum is caused by respiratory disease in rare cases and can be treated conservatively. It is important to confirm physical abdominal examinations, laboratory data, and radiological findings to avoid unnecessary surgical procedures. The diagnosis of pneumoperitoneum associated with respiratory disease requires the exclusion of other fatal illnesses, especially gastrointestinal perforation. © 2020 The Authors. Clinical Case Reports published by John Wiley Sons Ltd.Minor trauma rarely triggers a retroperitoneal abs