To the Editor.—This communication presents an uncommon gynecologic cause of pneumoperitoneum: dehiscence of the vaginal cuff after transvaginal hysterectomy.
Report of a Case.—A 41-year-old woman, gravida O, with a two-year history of biliary colic, complained of a feeling of upper abdominal fullness and bloating with right upper abdominal quadrant pain that lasted for seven hours and was not relieved by glycopyrrolate. She attempted to relieve the pain by sitting in her whirlpool bath and, while there, felt a sudden "pop" in her left lower abdominal quadrant and groin followed by generalized abdominal pain with radiation to the right shoulder. Coughing and abdominal motion significantly exacerbated the pain. The patient had no other gastrointestinal tract or gynecologic symptoms and specifically denied recent coitus or unusual sexual activity.
Her medical history was pertinent for an appendectomy performed 20 years previously and a transvaginal hysterectomy performed for contraception four months prior