What is in? Pneumoperitoneum after sexual intercourse.

To cite: Botelho P, Carvalho AF, Torrão H, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2013-009667 DESCRIPTION A 49-year-old woman presented to the emergency department with severe abdominal pain after vigorous sexual intercourse. The patient had a history of hysterectomy (due to cervix carcinoma) 3 months before and due to postoperative haematic losses, the patient frequently used tampons. The patient claimed she had a tampon within the abdominal cavity after sexual intercourse. An initial gynaecological examination showed no evidence of vagina vault damage and foreign body. Since abdominal pain persisted, the patient was submitted to an abdominal–pelvic CT scan that revealed a pneumoperitoneum and the presence of a foreign body in the abdominal cavity (arrow in figure 1A). The patient underwent minilaparotomy, and a tampon was found among intestine ansae (figure 1B); this occurred due to the total rupture of the vaginal vault, which was repaired through colporrhaphy. There were no significant events in the postoperative period. This case serves to highlight the relevance of patient self-report, sometimes so underestimated by clinicians and presents for the first time in literature the CT imaging of a tampon in the abdominal cavity.