Pneumoretroperitoneum mimicking rectal perforation, secondary to vaginal wall laceration following sexual intercourse in a 19-year-old woman in Korea: a case report

We report a rare case of pneumoretroperitoneum caused by a vaginal wall laceration following sexual intercourse, including anal intercourse, in a 19-year-old woman. The patient presented with abdominal pain and syncope. Abdominal computed tomography revealed free air in the retroperitoneal space, initially raising suspicion for rectal perforation. However, intraoperative colonoscopy confirmed the rectum was intact. A subsequent gynecological examination identified a 4-cm laceration in the lateral fornix that directly communicated with the retroperitoneal space. The injury was surgically repaired, and the patient achieved a full recovery without complications. This case underscores the importance of considering vaginal trauma in the differential diagnosis of pneumoretroperitoneum, particularly in sexually active young women. A prompt gynecological evaluation can prevent misdiagnosis and unnecessary interventions. In stable patients without signs of infection or peritonitis, conservative management following surgical repair may suffice. To our knowledge, this is the first reported case of pneumoretroperitoneum following sexual intercourse in the absence of rectal injury.