Pneumoperitoneum 48 days after laparoscopic hysterectomy

Postoperative pneumoperitoneum following laparoscopic surgery is self-limited, typically resolving within days. We analyzed the case of a 48-y-old woman who presented with acute abdominal pain 48 d after a total laparoscopic hysterectomy. Imaging studies revealed free air under the diaphragm suggesting a perforated viscus. An exploratory laparotomy was performed, but no perforations or organic traumas were found intraoperatively. To the best of our knowledge, this is the longest period of time reported for persistent pneumoperitoneum after laparoscopic surgery. Absent clinical findings, introduction of atmospheric air into the abdominal cavity during the original laparoscopic surgery was the most likely cause and is supported by the literature. Pneumoperitoneum observed up to 48 d status post laparoscopic hysterectomy, in the absence of peritoneal signs, fever, leukocytosis, or hemodynamic instability, may be considered for expectant management and serial inspection for clinical change.