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June 27, 1977

Unusual Cause for Right-Upper-Quadrant Pain and Pneumoperitoneum

JAMA. 1977;237(26):2845. doi:10.1001/jama.1977.03270530053024

ACUTE abdominal pain in the right-upper quadrant associated with pneumoperitoneum in a middle-aged patient suggests a rather limited differential diagnosis: perforation of a hollow viscus or presence of an intraabdominal abscess containing gasforming organisms.

We report an additional cause of pneumoperitoneum: vaginal cuff dehiscence following vaginal hysterectomy.

Report of a Case  A 33-year-old woman came to the emergency room on April 10, 1976, complaining of abdominal pain in the left-lower and right-upper quadrants for two days after its onset. The pain was abrupt in onset, was noncramping, and occurred simultaneously in the right-upper and left-lower quadrants for four hours prior to admission. The patient also had pain in the right shoulder.Similar symptoms had bothered her one month prior to this admission. At that time the symptoms were more severe and more sudden, requiring admission to another hospital. Gastrointestinal contrast studies were uninformative, and she was discharged with the diagnosis