Pneumoperitoneum 48 Days After Laparoscopic Hysterectomy

Smith, Kevin S.; Wilson, Tiffany C.; Luces, LaToya; Stevenson, A.; Hajhosseini, Babak; Siram, Suryanarayana M.

doi:10.4293/108680813x13794522666446

Cited by 11 publications

(5 citation statements)

References 14 publications

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“…However, pneumoperitoneum can persist for several days and has been reported to occur 48 d after a total laparoscopic hysterectomy. In this particular patient, an exploratory laparotomy was performed, and there was no evidence of perforation or organic trauma [5]. A single patient in our cohort was found to have pneumoperitoneum on POD 23 and did not require additional surgical intervention.…”

Section: Discussionmentioning

confidence: 91%

Postoperative pneumoperitoneum: is it normal or pathologic?

Chapman

McIntosh

Jones

et al. 2015

Journal of Surgical Research

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Section: Discussionmentioning

confidence: 91%

Postoperative pneumoperitoneum: is it normal or pathologic?

Chapman

McIntosh

Jones

et al. 2015

Journal of Surgical Research

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“…Evidence suggests that most episodes of residual pneumoperitoneum following laparoscopic surgery resolve within 3 days, with up to 96 % of cases resolving within a maximum of 7 days [4]. However, there have been some individual case reports of patients presenting with acute abdominal pain secondary to post-operative pneumoperitoneum at up to 48 days following the original procedure [5]. This was most likely to be a diagnosis of exclusion, in which no other surgical or non-surgical cause for the pneumoperitoneum could be elicited.…”

Section: Discussionmentioning

confidence: 95%

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

Anstis

Eskandar

2016

Gynecol Surg

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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.

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“…Image evaluations, therefore, generally show small amount of intra-abdominal gas in two or 3 days after operation but extremely rarely present long-lasting intra-abdominal free air beyond postoperative 7 days. Smith et al [ 11 ] reported a patient with prolonged free air observed in 48th day after laparoscopic hysterectomy. Detailed mechanisms of the free air retention in the abdominal cavity for a long time remain uncertain.…”

Section: Discussionmentioning

confidence: 99%

Liver Abscess and Prolonged Postoperative Intra-Abdominal Free Air without Anastomotic Leakage after Laparoscopic Gastrectomy

Kataoka¹,

Oura²,

Makimoto³

2022

Case Rep Gastroenterol

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An 84-year-old thin, i.e., body mass index of 17.8, woman with gastric cancer underwent laparoscopic distal gastrectomy and lymph node dissection followed by Roux-en-Y reconstruction. During the operation, Nathanson liver retractor (NLR) was used to press the left lobe of the liver. The patient recovered uneventfully and was discharged on the 9th postoperative day. The patient, however, developed abdominal pain just on the day of discharge. Sudden onset of the abdominal pain and massive free air on computed tomography made us do diagnostic laparoscopy. Detailed laparoscopic observation showed slight liver swelling at the pressure site of the NLR, superficial band-shaped color change on the left lobe of the liver, and no anastomotic leakage, suggesting the massive free air caused by prolonged retention of postoperative intra-abdominal air. Two days later, persistent fever, inflammatory findings, and presumed liver abscess showing no healing tendency made us do ultrasound-guided aspiration to the liver focus. Bacterial culture test showed the bacterium <i>Escherichia coli</i>, being sensitive to meropenem. Despite the failure of abscess drainage, antibiotic therapy using meropenem gradually alleviated her symptoms and the patient was discharged from the hospital in 15 days after the abscess aspiration. Surgeons should note possible prolonged postoperative intra-abdominal free air and liver abscess without anastomotic leakage after laparoscopic gastrectomy especially in thin patients to avoid inappropriate postoperative management.

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Pneumoperitoneum 48 Days After Laparoscopic Hysterectomy

Abstract: Postlaparoscopic pneumoperitoneum is usually self-limited to a few days. The presence of free air under the diaphragm of a patient with acute abdominal pain 48 days after total laparoscopic hysterectomy prompted an exploratory laparotomy during which no perforations were found.

Cited by 11 publications

References 14 publications

Postoperative pneumoperitoneum: is it normal or pathologic?

Postoperative pneumoperitoneum: is it normal or pathologic?

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

Liver Abscess and Prolonged Postoperative Intra-Abdominal Free Air without Anastomotic Leakage after Laparoscopic Gastrectomy

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