Plain x-ray is an important initial radiographic assessment step for patients presenting with clinical manifestation of perforated viscus. The patient was hemodynamically stable hence, an optimal radiographic imaging technique was performed.

Proper technique requires the patient to remain in desired plane position for as little as 5 minutes and a supine abdominal radiograph along with either an erect chest or a left lateral decubitus radiograph is obtained.

Some of the pneumoperitoneum signs seen in radiographs - which were reported in literature - are illustrated in the current case presented:

• right and left-sided free air under the diaphragmatic spaces
• doge cap sign: radiolucent collection of free air in Morison’s pouch between the posterior hepatic edge and anterior aspect of the right kidney
• Rigler's sign: the appearance of bowel walls on when they are outlined by intraluminal and extraluminal (peritoneal) air