Presentation
Fever, 2 days post-cholecystectomy.
Patient Data
Linear atelectasis in the left middle zone, and diffuse interstitial markings. No features of focal consolidation.
Air under the right hemidiaphragm indicative of small pneumoperitoneum. This is consistent with history of recent abdominal surgery.
Case Discussion
Post-operative pneumoperitoneum is a common finding on radiographs and is rarely of clinical importance. They can be detected on plain film radiographs for up to 10 days post-operatively but tend to be small (less than 2 cm in height) 1. Smaller pneumoperitoneum can be detected on CT in as many as 50% of patients 6 days post-operatively 2. A large and/or persistent pneumoperitoneum which does not improve over time may be a hallmark of perforation.
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