Free gas in the peritoneal cavity is not always associated with gastrointestinal perforation. The study presented a case of a 72-year old male patient with peritoneal emphysema, which developed after ventilation therapy. Suspecting gastrointestinal perforation the patient was subjected to laparotomy, which did not show perforation. The patient was diagnosed with spontaneous pneumoperitoneum. The patient died, due to cardiopulmonary and neurological disturbances. Withdrawal from non-therapeutic laparotomy may prove crucial in similar cases.