Percutaneous endoscopic gastrostomy (PEG) is the best approach to feeding patients not eligible for oral nutrition who have a functioning digestive system. Pneumoperitoneum after PEG is a relatively common complication. As regards management, the most important decision is whether conservative therapy or an exploratory laparotomy should be indicated. We report the case of a patient with giant pneumoperitoneum following PEG, who was successfully managed with percutaneous air drainage.