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Pneumoperitoneum

Case contributed by Andrew Van
Diagnosis certain

Presentation

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

Patient Data

Age: 58-year-old
Gender: Female
x-ray

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

x-ray

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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