Pneumoperitoneum

Dr Jeremy Jones et al.

Pneumoperitoneum describes gas within the peritoneal cavity, and is often the harbinger of a critical illness. There are numerous causes and several mimics (see article: pseudopneumoperitoneum).

The most common cause of pneumoperitoneum is from the disruption of the wall of a hollow viscus. The causes for pneumoperitoneum in children is different from the adult population and is considered elsewhere: see neonatal pneumoperitoneum.

The causes of pneumoperitoneum are wide and the severity of accompanying illness is also variable:

Plain radiograph
Chest radiograph

An erect chest x-ray is probably the most sensitive plain radiograph for the detection of free intraperitoneal gas. If a large volume pneumoperitoneum is present, it may be superimposed over normal aerated lung with normal lung markings.

Abdominal radiograph

Free gas within the peritoneal cavity can be detected on an abdominal radiograph. These signs can be further divided by anatomical compartments in relation to the pneumoperitoneum:

Ultrasound

May be useful in the appropriate clinical setting. A linear-array transducer (10-12 MHz) is considered more sensitive than standard curvilinear abdominal transducer (2-5 MHz).

Recognised features include:

  • enhancement of the peritoneal stripe (peritoneal stripe sign) 7.
    • either alone or with associated posterior multiple reflection artifacts or dirty shadowing.
    • may be accompanied by posterior artefactual reverberation echoes with a characteristic comet-tail appearance.
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Article Information

rID: 6165
Section: Gamuts
Synonyms or Alternate Spellings:
  • Free peritoneal air
  • Free peritoneal gas

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    Case 1: with subdiaphragmatic air
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    Case 2: with Rigler's sign
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    Free peritoneal g...
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    Case 4
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    Case 5: on ultrasound
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      Case 6
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    Case 7: with free subdiaphragmatic air
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    Case 8
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    Case 9
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    Case 10
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    Case 11
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    Extensive pneumop...
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    Case 14
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    Case 18
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    Assited erect rad...
    Case 19: neonate
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    Case 20: penetrating abdominal trauma
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    Case 21
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    Case 22: barotrauma
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    Case 23: with Rigler's sign
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    Case 24: Left lateral decubitus shoot through
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    Case 25: with subdiaphragmatic air
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