Pneumoperitoneum and ascites secondary to bacterial overgrowth

Abdominal bloating, weight loss, pneumoperitoneum, and ascites developed in a 73-year-old woman. She had scleroderma, megajejunum, small bowel dysmotility, and bacterial overgrowth. After treatment with a course of antibiotics, the pneumoperitoneum and ascites resolved, but her symptoms and the pneumoperitoneum recurred after the antibiotics were stopped. She was placed on cyclical antibiotics, and during a 2-year follow-up period she has remained well. The pneumoperitoneum and ascites may have been secondary to small bowel bacterial overgrowth. Ours is the first case that demonstrates this association.