Case contributed by Dr Andrew Van


Generalised abdominal pain and vomiting. Recent hospital admission for small bowel obstruction.

Patient Data

Age: 58-year-old
Gender: Female

Evidence of Rigler's sign in the right hypochondrium. Dilated small bowel loops with faecalisation of contents of the distal small bowel loops.


Evidence of free gas under the domes of the diaphragm.  Normal cardiac size, minor atelectasis lung bases. No pleural effusion.

Case Discussion

Rigler's sign (double wall sign) and the presence of air under both hemidiaphragm are indicative of a pneumoperitoneum. The patient was recently managed conservatively in the hospital for a small bowel obstruction two weeks prior.

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Case information

rID: 45431
Published: 25th May 2016
Last edited: 4th Jul 2017
Inclusion in quiz mode: Included

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