Dear Editor, I would like to congratulate the authors of this well written article and to thank them for the contribution to the literature. There is, however, one point that needs to be addressed, and that is the outcomes of surgical versus conservative treatment. Areview article1 has published data on 266 patients (106 patients derived from published case reports containing individual patient data, 113 patients derived from the Norwegian patient registry and data on 47 patients as historical controls from a previous publication and used as historical controls(Chendrasekhar et al2). It seems that conservatively treated patients had similar hospital length of stay as operated patients. Age did correlate with hospital stay, howeverno difference in outcomes for operated or non-operated patients was found. The historical control group did show a significantly higher mortality, implying that attempting conservative therapy after diagnosis through an abdominal CT scan (which often does show pneumoperitoneum) can only benefit this frail patient group.