Pneumoperitoneum: triangle of gas

Case contributed by Ian Bickle
Diagnosis certain

Presentation

Abdominal pain.

Patient Data

Age: 85 years
Gender: Female

Lungs clear.

Free air under the diaphragm and between bowel loops (triangles of gas).

Distended fecal filled bowel down to the pelvis.

Annotated image

A triangle of free interloop gas (pneumoperitoneum) in the right upper quadrant (blue triangle).

Case Discussion

This patient has a laparotomy which identified a large bowel obstruction with a tumoral perforation in the sigmoid colon.

Pneumoperitoneum in the abdomen may be apparent as triangles of interloop free gas on abdominal radiograph.  This has been referred to as the telltale triangle sign.

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