INTRODUCTION:Pneumoperitoneum refers to the presence of freegas within the peritoneal cavity. The plain filmssigns of pneumoperitoneum are both diverse andsometimes difficult to identify.Pneumoperitoneum is most often caused byperforated abdominal viscus and can present anacute medical emergency.
“The Radiological signs of pneumoperitoneum are among the most important signs in radiology, indeed in Medicine. Sometimes the amount of free gas is small and you may have to work to demonstrate it (i.e. modify the film technique). Miss it and the patient may die”
A 51-year-old man presented to the ED with progressive abdominal pain of one days duration. He had not eaten all day and had vomited twice. There was no associated diarrhea or melena.He had a history of alcoholic hepatitis, COPD, and surgical repair of a colonic-bladder fistula 10 years earlier. He had mild constipation and abdominal discomfort for the past few months.On examination, the patient was in moderate distress due to abdominal pain. Vital signs: blood pressure 130/70 mm Hg; pulse 118 beats/min; respirations 24 breaths/min; temperature 100.8º F (rectal).His abdomen was distended but soft, with mild diffuse tenderness and no rebound tenderness. His stool was negative for occult blood. He was anicteric
The best radiographic view for detecting freeintraperitoneal air is the upright chest radiograph
Look 4 air• Anterior subhepatic space free air• Morrison’s pouch• Air anterior to ventral surface of liver• Decubitus abdomen sign• Rigler’s sign on supine• Falciforme ligament sign• The “football “signe Air
• Continuous Diaphragm sign• Double bubble sign• The Cupola sign• Lesser sac gas• The triangle sign• Pneumoretroperitoneum