Pneumoperitoneum, abdominal pain and paralytic ileus in the postoperative period are usually related to perforation of the gastrointestinal tract. The authors present a case of a patient submitted to cesarean section (abruptio placentae) who had a postoperative course of abdominal distention and abdominal pain. Abdominal X-ray showed important dilatation of the colon and small bowel. Pneumoperitoneum was seen on chest X-ray. An exploratory laparotomy was performed because of suspicion of intestinal perforation. The operation showed a marked dilatation of bowel, pneumoperitoneum, and infected hemoperitoneum and subaponeurotic hematoma (Escherichia coli), without any perforation. Postoperative recovery was good and antibiotics were given for 4 days (ceftriaxone + metronidazole). The patient was diseharged from hospital on the 7th day after laparotomy. After review of the literature the authors concluded that this case of pneumoperitoneum was probably related to infection by a gas-producing bacterium in a patient with clinical findings of paralytic ileus.
Pneumoperitoneum; Postoperative complications; Cesarean section; Puerperium