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Rigler and telltale triangle signs - pneumoperitoneum

Case contributed by Marianne Cossens
Diagnosis certain

Presentation

Abdominal pain

Patient Data

Age: 25 years
Gender: Male

Distended loops of small bowel and sigmoid colon, measuring up to 6 cm.

Free intraperitoneal gas indicated by Rigler's sign and the presence of radiolucent triangles of gas in the right upper quadrant (telltale triangle sign).

Case Discussion

The patient had a history of Crohn's disease. He was taken to theater (with no need for CT imaging). Intraoperative findings- perforation of distal small bowel at the point of a Crohn's stricture. 85 cm of small bowel were resected.

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