73-year-old woman with a personal history of hypertensive heart disease, hypercholesterolemia, type II diabetes, hysterectomy for uterine prolapse and correction of cystocele, primary hypothyroidism, trigeminal neuralgia, bronchial asthma, depression, arteriosclerosis, cholecystectomy for gallbladder adenomyoma, adrenal insufficiency and bilateral nephrectomy: right due to pseudotumour and left due to abcessed haematoma, which has led her to remain on renal replacement therapy with continuous ambulatory peritoneal dialysis (CAPD) since January 2011. During the training period and in subsequent consultations, there was no evidence of poor performance of the technique by the patient, nor did she report symptoms of pneumoperitoneum.

In March 2013, she came to the emergency department with abdominal pain, diarrhoea, nausea without vomiting and chills without fever.

Physical examination in the emergency department revealed pain on palpation, predominantly in the right iliac fossa, skin pallor and limbs without oedema. BP: 100/60, Fc: 94 bpm, afebrile, Fr: 24 rpm, Sat.O2:89%. Laboratory tests were performed (haemogram, biochemistry and venous blood gases), chest and abdominal X-ray showing a well-placed peritoneal dialysis catheter and pneumoperitoneum. After being assessed by the surgery department, a CT scan with oral contrast showed a significant pneumoperitoneum, with no contrast leakage or perforation of a hollow viscera.

Once the initial nursing assessment had been carried out, with the above data and the patient interview, no problems were observed with the technique.

We proceeded to perform a peritoneal dialysis exchange according to protocol, to assess the possibility of peritoneal infection. No signs of infection were observed (clear peritoneal fluid), a sample of fluid was collected for culture and analysis, with the result: leukocytes: 80/uL, thus ruling out peritoneal infection.

Given the patient's condition, she was admitted for observation. She was placed on an absolute diet and serum therapy.

Given the possibility that the pneumoperitoneum was related to the peritoneal dialysis technique, it was decided that the nursing staff would perform the peritoneal dialysis exchanges according to the guidelines and, after drainage, place the patient in the Trendelemburg position to encourage peritoneal air to escape.

Subsequent radiological studies show a gradual decrease in the pneumoperitoneum, which is almost completely resolved by the time the patient is discharged from the hospital.