A case report of spontaneous pneumoperitoneum after sexual intercourse following a total laparoscopic hysterectomy, bilateral saplingo-oophorectomy and infra-colic omentectomy

Abstract

The finding of pneumoperitoneum on a chest radiograph is most commonly associated with an underlying viscus perforation (Mularski et al. West J Med 170:41-46, 1999). Urgent surgical intervention, in particular emergency laparotomy, is often required in these cases. However, in 10 % of patients, a perforated viscus is not the precipitating cause of a pneumoperitoneum (referred to as a spontaneous or nonsurgical pneumoperitoneum (SP). These cases are rarely associated with peritonitis and are usually managed conservatively (Mularski et al. West J Med 170:41-46, 1999; Pitiakoudis et al. J Med Case Rep 5:86, 2011). We present a case of a 28-yearold female presented to the Accident and Emergency department with a 6-h history of severe abdominal pain and bilateral shoulder tip pain. She reported that the pain developed 2 h following sexual intercourse. She had undergone a laparoscopic total hysterectomy, bilateral saplingo-oophorectomy and infra-colic omentectomy for borderline ovarian tumours 25 days previ-ously. The most likely cause of this patient's acute abdominal pain was a spontaneous pneumoperitoneum secondary to sexual activity. Clinicians should be aware with the potential non-surgical causes for the presence of a pneumoperitoneum, particularly in patients who are not presenting with the other characteristic clinical features of an acute gastrointestinal perforation such as peritonitis, fever and elevated white cell count. These particular patients can be largely managed conservatively.

Pneumoperitoneum in a Patient with Endometriosis and Bilateral Salpingectomy after Sexual Activity

“…The likelihood of pneumoperitoneum following hysterectomy usually peaks shortly after the surgical procedure, making it advisable for patients to abstain from sexual activity for a period of 6 to 8 weeks after undergoing such high-risk gynaecological surgeries [5]. Furthermore, two cases reported the presence of spontaneous pneumoperitoneum following sexual activity, one of which was for a patient with bilateral salpingectomy [5,8]. Although many reports have documented the presence of pneumoperitoneum due to gynaecological causes, none have reported perforation due to endometriosis, further highlighting the rarity of the patient described in this report.…”

Vaginal Cuff Dehiscence Presenting with Free Air 60 Days after Robotic-Assisted Hysterectomy

“…Numerous case reports have demonstrated pneumoperitoneum following hysterectomy and sexual intercourse. However, a review of the literature reveals that cases of pneumoperitoneum following both genital and oral-genital intercourse are typically associated with onset of symptoms 2–4 hours after sexual activity [ 3 – 5 ]. Similarly, the longest timespan for pneumoperitoneum associated with laparoscopic hysterectomy previously reported was 48 days postoperatively with no preceding sexual intercourse [ 6 ].…”