Key learning points/conclusion: this case report illustrates that pi could be a rare gastrointestinal complication and presentation of ssc- myositis overlap syndrome, therefore clinicians should be aware of this uncommon manifestation of ssc. other more common differentials such as inflammatory bowel disease, infections or even an underlying malignancy must be thoroughly assessed for and excluded. pneumoperitoneum in the context of ssc-associated pi is generally benign in nature, spontaneous i.e. non-surgical and it occurs as a result of spontaneous rupture of the air-filled cysts within the gastrointestinal walls, rather than due to true bowel perforation. pi with or without pneu- moperitoneum in patients with ssc is usually asymptomatic and only discovered incidentally on imaging or screening endoscopy. however, patients can present with more acute symptoms such as generalised abdominal pain/tenderness, distension and/or vomiting. these clinical presentations and imaging findings may simulate acute surgical abdo- men such as bowel perforation and/or ischaemia, leading to diagnostic dilemma and unnecessary or inappropriately risky surgical interven- tions. therefore, a precise diagnosis of pi and correct interpretation of its clinical significance are crucial, since pi is generally managed con- servatively with favourable response. surgical treatment is generally not preferred because gi involvement in ssc is almost always extensive, and operative manipulation is likely to result in post-operative complications. however, emergency laparot- omy should be considered in patients who exhibit signs of peritonism or bowel ischaemia and therefore timely involvement of surgeons and multidisciplinary team is essential