Post-cesarean pneumoperitoneum beyond expected revealing a sealed cecal perforation: a case report

Progressive post-cesarean pneumoperitoneum, even with a negative contrast study, should prompt a high index of suspicion for concealed bowel perforation. Correlating serial imaging with inflammatory markers and peritoneal fluid analysis can guide timely intervention. When identified early, and when intraoperative contamination is limited, bowel-preserving primary repair with drainage can achieve favorable maternal outcomes.