Background and Aims Aim – Discuss a case report of pneumocephalus which is a rare complication after combined spinal epidural anaesthesia (CSE). Background – A 21 years old female P2L2 presented with complaint of abdominal pain.NCCT Abdomen suggested that intrauterine copper containing device (CuT) is in pelvic cavity not in uterine cavity. She was diagnosed with misplaced CuT and planned for laparotomy under CSE anaesthesia.

Methods We retrospectively reviewed a case of a 21 years old female P2L2 with misplaced CuT and planned for laparotomy under CSE anaesthesia. Intraoperatively she was prepared for CSE in sitting position in L3-L4 space. Epidural space was identified with loss of resistance to air in syringe method. On puncture of dura with spinal needle patient started complaining of a sudden severe headache and vomiting. Procedure was abandoned and deferred for post evaluation.

Results Post operatively in CT head subdural air collection was seen in bilateral frontal right more than left with extension into falx, multiple air pockets in left side of cerebellar left temporal and bilateral occipital and parietal region suggestive of pneumocephalus.

Conclusions Pneumocephalus is a rare complication after CSE. The possible entry of air in subarachnoid space by displacement of epidural needle from epidural space to subarachnoid space could be while checking loss of resistance through air in syringe method or when spinal needle was inserted through epidural needle or when the stylet had been withdrawn from spinal needle. The appearance of neurologic symptoms like sudden headache in patients undergoing epidural or spinal anaesthesia suggests the possibility of pneumocephalus.