Postpartum pneumoperitoneum

Case contributed by Dr Avni K P Skandhan

Presentation

A patient who was 1 week post LSCS, presented to the casualty with acute distension of abdomen.

Patient Data

Age: 30 years
Gender: Female

Non contrast, axial images of abdomen in lung window settings

CT

Moderate to massive pneumoperitoneum. Multiple air filled bowel loops noted, however, no abnormal dilatation of these loops is seen. No free fluid. No evidence of diverticulae, intrauterine air or any fluid collections.

Case Discussion

A patient who underwent LSCS one week prior 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 Cesarean-section 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 diverticulae, fluid collections, intrauterine or periuterine air, no bowel wall cysts, no free fluid etc.

There was no cause for the pneumoperitoneum found after detailed examination. There was no history of laparoscopic surgery, no pelvic examinations or exercises post delivery, no bowel pathology detected, no features of peritonitis could be elicited.

The patient's discomfort was relieved by syringing out the intraperitoneal air. Following this, the patient was stable and was discharged after a week of observation. The follow x-ray showed no evidence of pneumoperitoneum.

Though there are documented instances of minimal pneumoperitoneum developing post delivery, the amount of air in our case was unexplainable especially in absence of any other bowel pathology.

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