Presentation
Generalized abdominal pain and vomiting. Recent hospital admission for small bowel obstruction.
Patient Data
Evidence of Rigler's sign in the right hypochondrium. Dilated small bowel loops with fecalization 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.