A Case Report on Pneumoperitoneum Secondary to Tubo-ovarian Abscess

We present the case of a 17-year-old patient who presented with acute abdomen and raised inflammatory markers and had laparoscopy for suspected bowel perforation based on the finding of pneumoperitoneum on CT scan. Pneumoperitoneum on an X-ray or computed tomography (CT) imaging indicates a ruptured viscus, and surgery is required right away. A case of tubo-ovarian abscess (TOA) presenting with pneumoperitoneum is unusual. Very few cases have been reported where the pneumoperitoneum is caused by an abscess involving the adnexa. Bowel perforation was ruled out and the findings were consistent with TOA. She had drainage of the abscess, subsequently received intravenous antibiotics and postoperatively recovered well. The pneumoperitoneum could have been due to coinfection with E. coli, as the patient had had a urinary tract infection due to E. coli three weeks before presentation, or slow leakage of the TOA. In conclusion, gas under the dia- phragm can be related to non-bowel-related gynaecological pathology, but it vital to rule out sinister causes.