A patient who was 1 week post LSCS, presented to the casualty with acute distension of abdomen.
Non contrast, axial images of abdomen in lung window settings
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Moderate to massive penumoperitoneum. Multiple air filled bowel loops noted, however no abnormal dilatation of the same is seen. No free fluid. No evidence of diverticuli, intrauterine air or any fluid collections.
A patient who underwent LSCS, one week before presented to the emergency department with acute abdominal pain and severe abdominal distension. She had regular bowel motions and no vomiting. She was just ambulatory post cessarean and was not doing any active movements. She did not have any pelvic examinations or procedures done post the surgery.
On examination, she was found to be hemodynamically stable. She had a tense abdomen. The erect abdominal x ray and plain CT scan of the abdomen showed moderate to massive pneumoperitoneum.
There was no evidence of any diverticuli, fluid collections, intrauterine or periuterine air, no bowel wall cysts, no free fluid etc.
There was no cause for the pneumopertioneum found after detailed examination. There was no history of laproscopic surgery, no pelvic examinations or exercises post delivery, no bowel pathology detected, no features of peritonitis could be elicited.
Patients discomfort was relieved by syringing out the intraperitoneal air. Following which this patient was stable and was discharged after observing the patient for a week. The follow up x ray showed no evidence of pneumoperitoneum.
Though there are document instances of minimal pneumoperitoneum developing post delivery, the amount of air in our case was unexplainable especially in absence of any other bowel pathology.