Introduction: Pneumoretroperitoneum is defined as the presence of retroperitoneal air [1] revealed by imaging examinations such as abdominal radiography and computed tomography. The most common causes of pneumoretroperitoneum are intestinal perforation, gas bacterial infections, botulism, or complications of pneumomatosis intestinalis [2,3,4].

Case presentation: A 73-year-old patient, known with a significant cardiac pathology, liver cirrhosis, and past history of pulmonary TB, presented with an altered general status and pain in the left hypocondrium and flank and bilateral lumbus with irradiation in the lower limbs. The thoracic-abdominal-pelvic tomography revealed an osteolytic vertebral tumor at the level of the L5 vertebra with air content and pneumoretroperitoneum. The patient was monitored by a multidisciplinary team (general surgeon, neurosurgeon, anesthesiologist), the treatment being adapted to the complex pathology, with the improvement of the general status, the presumptive diagnosis being a vertebral tumor with intraspinal tissue or vertebral osteomyelitis. Surgery was suggested to the patient in order to biopsy the tumor but

he refused it.

Literature review: Most often in literature, pneumoretroperitoneum appears as a complication of the incidents encountered during endoscopic procedures, when the perforation of the intestine can occur. The imaging diagnosis of pneumoretroperitoneum can be done using abdominal and thoracic radiography, but the “gold standard” is computed tomography.

Conclusions: Pneumoretroperitoneum can have a multitude of causes, with extremely varied etiologies, the main cause being represented by intestinal perforation during colonoscopy. There is no standard protocol for choosing the treatment of the patients with pneumoretroperitoneum, the choice depending on the cause, the general status of the patient, and the surgeon's choice. represented by intestinal perforation during colonoscopy. There is no standard protocol for choosing the treatment of the patients with pneumoretroperitoneum, the choice depending on the cause, the general status of the patient, and the surgeon's choice.