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Postoperative Free Air and Fluid
KEY FACTS
Terminology
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Presence of intraperitoneal or body wall gas/fluid following surgery
Imaging
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Pneumoperitoneum is common imaging finding after surgery on both plain radiographs and CT
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CT has 2x sensitivity of plain films for detection of pneumoperitoneum
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Pneumoperitoneum is seen on CT in 87% of patients following uncomplicated laparotomy at 3 days post surgery and 50% of patients at 6 days
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No upper limit to normal persistence of pneumoperitoneum, but gas resolves in most patients within 1 week
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Pneumoperitoneum more likely to persist in patients who have had prior surgery or peritonitis, have undergone open (rather than laparoscopic) surgery, or who have surgical drains
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Volume of postoperative pneumoperitoneum is normally small (< 10 cc) in most patients
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Large or massive pneumoperitoneum is not normal finding, even in immediate postoperative setting
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Presence of massive pneumoperitoneum should raise concern for anastomotic leak or hollow viscus perforation
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Free intraperitoneal fluid is present in nearly all patients following open laparotomy or laparoscopy
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Small, nonloculated collections without enhancing wall or mass effect are of little concern
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Large volume free fluid or collection with mass effect, enhancing rim, or internal gas should raise concern for infected fluid collection or bowel/anastomotic leak
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Extraperitoneal collections (e.g., retroperitoneal and abdominal wall collections) of gas and fluid take longer to resolve than peritoneal air/fluid
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Peritoneum is much better absorptive surface than granulation tissue, fat, or muscle
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Axial NECT in a patient after surgery shows skin staples
in the anterior abdominal wall with evidence of free air
and perihepatic free fluid
. The patient was free of symptoms of infection or bowel leak and recovered without incident.
in the anterior abdominal wall with evidence of free air and perihepatic free fluid . The patient was free of symptoms of infection or bowel leak and recovered without incident.
Axial NECT in a patient after sigmoid colectomy demonstrates large amounts of free intraperitoneal gas
, much more than would be normally expected after surgery. Abundant free air after surgery must raise concern for an anastomotic leak or perforation.
, much more than would be normally expected after surgery. Abundant free air after surgery must raise concern for an anastomotic leak or perforation.
NECT in the same patient after administration of rectal enteric contrast demonstrates a leak of air & contrast media at the sigmoid anastomotic staple line
. Other collections of air & fluid
are noted.
. Other collections of air & fluid are noted.
Axial CECT in a patient with a recent hysterectomy shows a thin, encapsulated collection of gas and fluid
in the abdominal wall musculofascial plane at the incision site. Needle aspiration of the collection revealed no evidence of infection, and the collection resolved.
in the abdominal wall musculofascial plane at the incision site. Needle aspiration of the collection revealed no evidence of infection, and the collection resolved.
TERMINOLOGY
Definitions
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Presence of intraperitoneal or body wall gas/fluid following surgery
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