Post-cesarean pneumoperitoneum beyond expected revealing a sealed cecal perforation: a case report

Area of Science:

• Obstetrics and Gynecology
• Surgical Gastroenterology
• Diagnostic Imaging

Background:

• Post-cesarean delivery, small amounts of intraperitoneal air are common.
• Persistent or worsening pneumoperitoneum is atypical and may suggest hollow-viscus injury.

Purpose of the Study:

• To highlight the significance of progressive pneumoperitoneum following cesarean delivery.
• To emphasize the diagnostic value of serial imaging and laboratory findings in suspected bowel perforation.
• To present a case of successful primary repair of a sealed cecal perforation.

Main Methods:

• A case presentation of a 30-year-old female following cesarean delivery.
• Utilized serial computed tomography (CT) scans, including oral contrast, and peritoneal fluid analysis.
• Performed exploratory laparotomy for diagnosis and management of suspected occult perforation.

Main Results:

• The patient presented with symptoms of abdominal pain and distension on postoperative day 4.
• Serial CT scans revealed progressive pneumoperitoneum and bowel dilatation.
• Peritoneal fluid analysis identified extended-spectrum beta-lactamase-producing Escherichia coli; exploratory laparotomy confirmed a sealed cecal perforation.

Conclusions:

• Progressive post-cesarean pneumoperitoneum warrants a high suspicion for concealed bowel perforation, even with negative contrast studies.
• Integrating serial imaging, inflammatory markers, and peritoneal fluid analysis aids in guiding timely surgical intervention.
• Early diagnosis and limited intraoperative contamination allow for successful bowel-preserving primary repair, leading to favorable maternal outcomes.