Presentation
Severe generalized abdominal pain
Free gas (most important finding). There is a tract of gas from the distal stomach which is visualized posteriorly. This was the source for pneumoperitoneum.
Case Discussion
Findings: Free gas (most important finding). In the absence of known benign cause, diagnosis is perforated viscus. Tract of gas from distal stomach is visualized posteriorly, which was the source.
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Objectives:
To identify pneumoperitoneum and have a basic differential diagnosis
To practice identifying the source of pneumoperitoneum
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Protocolling:
Contrast enhanced CT
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Key points:
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Anatomy:
Review small and large bowel anatomy
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Differential diagnosis:
Perforated viscus (PUD, ischemic bowel, appendicitis, diverticulitis, etc)
Post-operative
Peritoneal dialysis
If perforated viscus is suspected, patient will go to OR.
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Identifying the source of free gas:
Amount and location of gas collections (assess for intra and retroperitoneal gas)
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Look for:
Localized air bubbles
Focal bowel wall thickening
Bowel wall discontinuity
Focal pathology (i.e. appendicitis, diverticulitis, PUD)
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