Resolution of free intraperitoneal air after laparoscopy: Utility of abdominal radiography in the diagnosis of bowel injury

Abstract

Bowel perforation is a life-threatening complication of operative laparoscopy that warrants immediate treatment. The classic radiographic signs of a ruptured viscus may be indistinguishable from intraperitoneal CO2 introduced during insufflation. To examine whether abdominal radiology could be useful in diagnosing a ruptured viscus after laparoscopy, we obtained upright abdominal films on 31 patients 24 hours after operative laparoscopy. The laparoscopic procedures ranged from lysis of adhesions to radical hysterectomy with lymph node dissection. Twenty-eight of the patients had no radiologic evidence of free air 24 hours postoperatively. Of the three patients who were found to have free air, one was asymptomatic, one had an acute abdomen that resolved, and another died after multiple surgeries to resolve what was found to be an unrecognized bowel perforation from a prior laparoscopic lysis of adhesions. Based on our findings, we believe that the presence of free air 24 hours after laparoscopy to be presumptive evidence of a ruptured viscus until proven otherwise.