Pneumoperitoneum following vaginal insufflation and coitus

A 25-year-old woman developed bilateral lower abdominal and pleuritic chest pain radiating to the shoulders 30 min after oral-genital insufflation and conventional coitus. Radiographic evaluation demonstrated a pneumoperitoneum. This was attributed to a traumatic 5-mm rent in the vaginal cuff occurring six months after post-vaginal hysterectomy. Mild symptomatology and the absence of peritoneal irritation should suggest a vaginal etiology for pneumoperitoneum, and allow consideration of conservative management. Post-coital pneumoperitoneum after abdominal hysterectomy has been reported; however, we believe this to be the first such reported case after vaginal hysterectomy and associated with oral-genital insufflation.