Massive pneumoperitoneum after nonabdominal cardiac surgery managed without laparotomy in a 50-year-old woman in India: a case report

Postoperative pneumoperitoneum after intraperitoneal procedures, such as laparoscopic surgery, is common and often clinically insignificant because it usually reflects residual free air. In contrast, benign pneumoperitoneum after cardiac surgery is extremely rare and may lead to unnecessary abdominal exploration if it is misinterpreted. We report the case of a 50-year-old woman who developed massive pneumoperitoneum 48 hours after drain removal following uncomplicated coronary artery bypass grafting (CABG). Despite concerning radiographic findings, she remained hemodynamically stable and had a benign abdominal examination. Contrast-enhanced abdominal computed tomography showed no evidence of gastrointestinal perforation. The pneumoperitoneum was attributed to air entry through the drain tract and was managed conservatively, with gradual resolution. Delayed pneumoperitoneum after CABG can occur in the absence of gastrointestinal perforation. Awareness of this rare but benign entity is important to avoid unnecessary surgical intervention.