Pneumoperitoneum commonly occurs due to perforated viscus, yet a minority of cases can occur due to gynaecological causes, particularly following sexual activities. While not yet established, various hypotheses have been posited to explain the development of a spontaneous pneumoperitoneum after sexual intercourse. We herein present a unique case of a woman with a history of endometriosis and bilateral salpingectomy who presented with sudden abdominal pain that started after sexual activity. Subsequently, an emergent diagnostic laparoscopy was deemed necessary yielding no signs of perforation. However, an endometrial island was identified on the stump of the previous right salpingectomy during the procedure. Finally, the most likely cause of the patient’s spontaneous pneumoperitoneum was determined to be secondary to sexual activity and subsequent air transmission through an opening caused by her endometriosis. In conclusion, this report will showcase the importance of considering gynaecological pathologies as potential causes of spontaneous pneumoperitoneum, particularly following sexual activity. We intend to diminish the stigma associated with using sexual history as a diagnostic tool when faced with ambiguous cases of abdominal pain presentations.

Surgery, Pneumoperitoneum, Sexual activity, Gynaecology, Perforation