Abstract Two cases of tension pneumoperitoneum seen in 2 female adults in the University College Hospital, Ibadan, are described. One was a complication of abdominal and pelvic tuberculosis with tuberculous ulcers of the colon detected at autopsy. The other developed tension pneumoperitoneum following puerperal sepsis. In neither was a site of perforation detected nor were gas-forming organisms grown on culture. The literature on the subject is reviewed.