Pneumoperitoneum secondary to gastrostomy is a rare, usually benign complication, often due to air insufflation. It can occur after both endoscopic and radiological techniques, though less frequently with the latter. Percutaneous radiological gastrostomy is preferred in neuromuscular patients where deep sedation poses respiratory risks. We report a case of a Duchenne muscular dystrophy patient on non-invasive ventilation who developed symptomatic pneumoperitoneum, likely exacerbated by aerophagia. We propose minimally managing this with a semi-permanent percutaneous drain, allowing continued ventilatory support until resolution.
