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 non-surgical 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-year-old 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 previously. 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.