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. In conjunction with multiple bowel fluid levels, the findings are suggestive of bowel perforation.
The patient was brought unconscious with severe abdominal pain. Given that the patient wasn't suitable for a conventional erect chest x-ray, the alternative was a left lateral decubitus shoot through. The patient is positioned left lateral decubitus for approximately 10 minutes, to allow intraperitoneal air in the lesser sac to pass through the foramen of Winslow into the greater sac and accumulate between the lateral liver and abdominal wall margins.