Abstract
Pneumoperitoneum, characterized by the presence of air in the peritoneal cavity, is usually associated with severe clinical conditions, such as perforations of hollow viscera, often requiring urgent surgical intervention. However, in rare cases, pneumoperitoneum occurs without an identifiable cause, thus classified as idiopathic pneumoperitoneum. We present two clinical cases of women who developed pneumoperitoneum after extensive gynecological surgeries. In the first case, a 63-year-old woman underwent elective hysterectomy and bilateral adnexectomy due to a large adnexal mass. In the second case, a 55-year-old woman had a similar surgical history. Both patients were treated conservatively, with a positive outcome. Idiopathic pneumoperitoneum is a diagnostic and therapeutic challenge, especially in the postoperative context. The cases presented underscore the importance of rigorous diagnostic evaluation and a cautious therapeutic approach, suggesting that idiopathic pneumoperitoneum may represent a benign and self-limiting phenomenon rather than a surgical emergency.