Small bowel obstruction with perforation

Case contributed by Dr Lee-Anne Slater


Acute abdominal pain in an ICU patient.

Patient Data

Gender: Male

Abdominal x-ray shows dilated bowel loops in keeping with a bowel obstruction. There is also evidence of associated perforation with evidence of Rigler's sign and a football sign on the supine film and free gas beneath the left and right hemidiaphragm on the erect film confirming this finding.

Annotated image

Arrows indicate free subdiaphragmatic gas. 

Case Discussion

Demonstrating evidence of perforation is very important as it usually results in an emergency laparotomy. As such looking for signs of free gas is essential.

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Case information

rID: 14591
Published: 8th Aug 2011
Last edited: 29th Sep 2015
Inclusion in quiz mode: Included

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