Anastomotic fart: a ubiquitous general surgical term not described in literature demonstrated in a case report

Post-operative pneumoperitoneum following abdominal surgery usually resolves within one week but may persist for 10 to 24 days (Gayer G, Hertz M, Zissin R. Postoperative pneumoperitoneum: prevalence, duration, and possible significance. <i>Semin Ultrasound CT MR</i>. 2004;25:286-9). However, a new or enlarging volume of pneumoperitoneum following bowel resection is almost inevitably a sign of catastrophe (Gayer G, Hertz M, Zissin R. Postoperative pneumoperitoneum: prevalence, duration, and possible significance. <i>Semin Ultrasound CT MR</i>. 2004 Jun;25(3):286-9, Chiarello MM, Fransvea P, Cariati M, Adams NJ, Bianchi V, Brisinda G. Anastomotic leakage in colorectal cancer surgery. <i>Surg Oncol</i>. 2022;40:101708). Operative management is usually required in these cases (Chiarello MM, Fransvea P, Cariati M, Adams NJ, Bianchi V, Brisinda G. Anastomotic leakage in colorectal cancer surgery. <i>Surg Oncol</i>. 2022;40:101708). 'Anastomotic fart' is a commonly used phrase in General Surgical departments, often used to denote an anastomotic leak of gas only and minimal to no faecal contamination of the peritoneal cavity. However, this term is devoid in any published literature. In this case we demonstrate an 'anastomotic fart' managed conservatively by describing a 90 year old man who developed a new massive pneumoperitoneum on Day 10 post-operatively. He was able to avoid further surgical management and was safely discharged back to his own home after 24 days.