Excessive crying and abdominal distension.
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Massive pneumoperitoneum is evident by the excessive free gas in the abdominal cavity, including the bilateral subphrenic spaces and surrounding the edges of the liver (hepatic edge sign). Bowel double wall sign (or Rigler sign) is well-demonstrated.
Some of the bowel loops are significantly dilated. Gas-fluid levels are seen in the dilated lower abdominal loops. No rectal gas is seen.
The features are most likely due to intestinal obstruction with bowel perforation.
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