Use of pelvic pneumoperitoneum: A critical assessment of 12 years' experience

Pelvic pneumoperitoneum has been acclaimed widely for its diagnostic value in the assessment of ovarian enlargement associated with polycystic ovarian disease. Various authors have made use of diverse parameters to estimate ovarian enlargement roentgenologically. Experience at this institution and two other institutions with over 1,000 pelvic pneumoperitoneums in adults and children has shown clearly the limitations of this procedure in assessing the size of pelvic structures. In general, pelvic pneumoperitoneum has its greatest use in the following general situations: (1) determining the presence or absence of gonadal structures and/or the müllerian system; and (2) accurate definition of anomalies of the uterus or müllerian system. Specifically, it is most helpful in the following conditions: (1) gonadal dysgenesis (neuter sex)—with or without neoplastic enlargement in the ridge; (2) vaginal atresia or vaginal pouch (to determine the presence or absence of the müllerian system); (3) isosexual precocious puberty—presence or absence of neoplastic enlargement of the ovary; (4) intersex disorders—status of the gonads and gonadal accessory structures; (5) uterus bicornis versus uterus subseptus; and (6) as an adjuvant in the examination of the posthysterectomy patient and after culdoscopy. The purpose of this paper is to emphasize the relative limitations of pelvic pneumoperitoneum in polycystic ovarian disease and to stress clinical situations in which it does have real value but has been used sparingly to date.