Abdominal pain 4 days post gynecological surgery.
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Evidence of recent gynecological surgery.
Gas locules extend throughout the properitoneal fat from the inferior margins adjacent to the pelvic sidewalls, up along the anterior abdominal wall deep to the rectus sheath and along the falciform ligament / intersegmental fissure of the liver. A few gas locules are also visible above the diaphragm in the epicardial fat deep to the xyphoid process and near the cardiac apex.
The properitoneum in this patient was inadvertently insufflated during her surgery 4 days prior. A repeat laparoscopy was performed due patient pain and low grade fever, which did not demonstrate any hollow viscus perforation.
This case is an excellent demonstration of the pro/preperitoneal space, particularly due to the abundant adipose tissue in these areas in this case. The parietal peritoneum is well seen in the mid abdomen, separating the gas locules within the properitoneal fat from the intraperitoneal space. A few gas locules are present above the level of the diaphragm, which may have traveled there via Larrey spaces. Note that there is no intraperitoneal gas, thus this is not pneumoperitoneum.