Pneumoperitoneum 48 days after laparoscopic hysterectomy

Area of Science:

• Minimally Invasive Surgery
• Abdominal Imaging
• Gastroenterology

Background:

• Postoperative pneumoperitoneum is common after laparoscopic procedures.
• It typically resolves spontaneously within a few days.
• Prolonged presence of free air requires careful evaluation.

Observation:

• A 48-year-old woman presented with abdominal pain 48 days post-laparoscopic hysterectomy.
• Imaging revealed free air, mimicking a perforated viscus.
• Exploratory laparotomy found no organic cause for the pneumoperitoneum.

Findings:

• This case represents the longest reported duration of persistent pneumoperitoneum post-laparoscopy.
• The likely cause was atmospheric air introduced during surgery.
• No intraoperative perforations or trauma were identified.

Implications:

• Pneumoperitoneum up to 48 days without clinical signs may be managed expectantly.
• Serial clinical observation is crucial for patients with prolonged pneumoperitoneum.
• This finding broadens the understanding of self-limited postoperative pneumoperitoneum.