Pneumoperitoneum following revision hip arthroplasty without hollow viscus perforation: a gastrointestinal surgical diagnostic challenge and the importance of clinical-radiological correlation.
Suhaib Js Ahmad, Mohammed Hammoda, Edgar Gelber et al.
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Case in brief
A woman in her 50s developed pneumoperitoneum after revision hip arthroplasty for prosthetic joint infection. Despite elevated inflammatory markers, her abdomen was soft and non-tender. CT imaging showed significant pneumoperitoneum without signs of bowel perforation or other complications. The air was traced from the acetabulum into the retroperitoneum, leading to a conservative management approach without the need for surgery.
What made this case unusual
The case highlights pneumoperitoneum arising from a non-visceral source post-hip arthroplasty, challenging the typical assumption of hollow viscus perforation.
Diagnostic / clinical pearl
Clinicians should consider non-visceral causes of pneumoperitoneum, especially after orthopedic procedures, to avoid unnecessary surgical interventions.
Why it matters
Understanding the potential for air introduction from surgical sites can prevent misdiagnosis and reduce the risk of avoidable morbidity associated with unnecessary laparotomies.