Pneumoperitoneum is almost always interpreted as evidence of visceral perforation and is an indication for immediate surgical intervention. Spontaneous, nonsurgical or idiopathic pneumoperitoneum indicates a condition in which evidence of visceral perforation cannot be found even with radiological evidence of pneumoperitoneum. Spontaneous pneumoperitoneum has been reported in 10% of all cases and is a surgical dilemma which requires proper assessment with a thorough history and physical examination. We report a 30-year-old woman suffered abdominal pain and fever with radiographically proven pneumoperitoneum, but no evidence of visceral pathology was detected intraoperatively.