Case contributed by Dr Balint Botz


Epigastric pain, vomiting, constipation, abdominal distension for two days.

Patient Data

Age: 79
Gender: Male

Erect AP abdominal radiograph

Significant amount of crescentic free air is visible under both hemidiaphragms. Furthermore an air-fluid level is visible on the right (see key image), highly suggestive of abdominal free fluid (confirmed by US). Distended loops of small bowel are also visible in the left upper quadrant with characteristic double wall (Rigler)-sign in the region containing free extraluminal air (key image). The stomach is also distended.

Case Discussion

The findings are in line with pneumoperitoneum caused by bowel perforation, consequent adynamic ileus and buildup of free fluid. The patient was admitted for surgery, which confirmed perforation of the pyloric part of the duodenum complicated by peritonitis. 

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Case information

rID: 57217
Published: 12th Dec 2017
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included
Institution: University of Pécs

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