Jacuzzi-Induced Pneumoperitoneum: Case Report and Literature Review.

Description Radiographically-detected pneumoperitoneum in the setting of acute onset abdominal pain is a classic case among surgical emergencies. The spectrum of etiology ranges from benign to catastrophic, and the ability to differentiate depends in large part on the history and physical exam findings. Included among non-surgical types of pneumoperitoneum are (1) post-operative, (2) diagnostic/experimental, (3) gynecologic tract air entry, (4) the difference in intra- and extra-alveolar pressures, pneumothorax-associated and (5) miscellaneous. Jacuzzi-induced pneumoperitoneum is an extremely rare form of non-surgical pneumoperitoneum. We discuss a case of a 32-year-old female presenting with pneumoperitoneum and acute onset abdominal pain secondary to vaginal insertion onto a Jacuzzi jet. We describe the workup and management of this case and perform a literature review of reported cases of Jacuzzi-induced pneumoperitoneum. Although its presentation is dramatic, a prudent physical exam, history and appropriate imaging are key to the management of this non-surgical condition.