- Inadvertent peritoneal breach
- Dissection around the diaphragm and retroperitoneum
- Nissen's fundoplication, gastric bypass surgery, urologic surgery
- Misdirected Veress needle: (damage to falciform ligament)
- Gas tracked through facial planes from the neck and thorax into the mediastinum and pleural space
- Passage of gas through the pleuroperitoneal hiatus (foramen of Bochdalek)
- Passage of gas through congenital defects (foramen of Morgagni)
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