Post operative pneumoperitoneum


  • A 41 years old lady
  • Post laparotomy day 2
Chest radiograph PA erect view

Radiographic findings:

  • Free gas is seen under the dome of right hemidiaphragm (red arrows)
  • Left hemidiaphragm is elevated, no free air seen under it
  • The aerated lung fields are normal.
  • Visualized bones are unremarkable
  • No pneumomediastinum or pneumothorax

Radiologic diagnosis: Post operative pneumoperitoneum.


  • Pneumoperitoneum should be differentiated from other types of extraluminal intra-abdominal gas.
  • Causes of pneumoperitoneum include following laparotomy/laparoscopy, colonic perforation, perforated peptic ulcer, introduction per vaginal e.g douching and idiopathic.
  • Free gas under the diaphrag can detect minimum 10 mls of air and 10 minutes may be needed for all gas to rise in erect /semierect position
  • Post operative pneumoperitoneum occurs in up to 60% of laparotomies and 25% of laparoscopic procedures
  • If the volume of gas increases then another cause of pneumoperitoneum should be sought
  • If there are no features of peritonitis or other concerning features, management is conservative and the gas will gradually be reabsorbed
  • Two-thirds of cases resolve within 48 hours and 97% resolve within 5 days

Progress of patient:

  • Patient was managed conservatively
  • HPE came back as adenomyosis and right endometriotic cyst
  • Patient recovered uneventfully
Preoperative CT scan done shows complex cystic mass at right adnexa




Author: radhianahassan