Pneumoperitoneum in a premature neonate
Discussion:
Laparotomy revealed a solitary ileal perforation.
Pneumoperitoneum is a surgical emergency, and hence its imperative to be familiar with a radiograph appearance of free intraabdominal air on erect, supine and lateral decubitus views. The importance of supine radiographic interpretation has been emphasized in neonates and infants where erect X-rays are seldom opted for.
Various signs have been described on supine and erect radiographs, namely
- copula sign - pathognomic on erect views only
- Rigler sign
- liver signs: anterior subhepatic linear air, Morrison pouch air (Doges cap sign), Lucent liver sign, liver edge sign
- football sign
- falciform ligament sign
- urachus sign
- coronary ligament outlined by air
- continuous diaphragm sign
- triangle sign
- dancing/Leaping dolphin sign at diaphragmatic muscle slips
- Inverted V sign
- scrotal air
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