title: Pneumoperitoneum 48 days after laparoscopic hysterectomy.
abstract: OBJECTIVE
  Postoperative pneumoperitoneum following laparoscopic surgery is self-limited, typically resolving within days.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Howard University Hospital, Department of Obstetrics & Gynecology, 2041 Georgia Ave NW, WA, DC 20060, USA. k_smith@howard.edu.
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Smith
authors.affiliation: Howard University Hospital, Department of Obstetrics and Gynecology, WA DC, USA.
authors.forename: Tiffany C
authors.initials: TC
authors.lastname: Wilson
authors.affiliation: Howard University Hospital, Department of Obstetrics and Gynecology, WA DC, USA.
authors.forename: LaToya
authors.initials: L
authors.lastname: Luces
authors.affiliation: Howard University Hospital, Department of Obstetrics and Gynecology, WA DC, USA.
authors.forename: Adrienne A
authors.initials: AA
authors.lastname: Stevenson
authors.affiliation: Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
authors.forename: Babak
authors.initials: B
authors.lastname: Hajhosseini
authors.affiliation: Howard University Hospital, Department of Obstetrics and Gynecology, WA DC, USA.
authors.forename: Suryanarayana M
authors.initials: SM
authors.lastname: Siram
mesh_terms: D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects* / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D011027:Pneumoperitoneum / Q000209:etiology*; D013997:Time Factors