Bowel perforation - pneumoperitoneum
Young adult presented with severe abdominal pain, guarding and rigidity.
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Large amount of intraperitoneal air noted bounded by abdominal wall, lateral border of liver and inferior surface of diaphragm along with fluid level suggestive of bowel perforation.
The patient was brought unconscious and severe abdominal pain. and id the the patient couldn't afford to stand for conventional chest x ray, a better alternative is left lateral decubitus shoot through. Patient is allowed to lie down in left lateral decubitus for around 10 minutes, so that intraperitoneal air in the lesser sac can pass through foramen of Winslow into the greater sac and accumulate between lateral margin of liver and lateral abdominal wall.