The football sign is seen in cases of massive pneumoperitoneum, where the abdominal cavity is outlined by gas from a perforated viscus. The median umbilical ligament and falciform ligament are sometimes included in the description of this sign, as representing the sutures.
Which football is used as the model ball varies according to the nationality of the author. Rugby, Australian rules and American football all have balls that fit the bill. Soccer is clearly not appropriate.
It is most frequently seen in children with advanced necrotizing enterocolitis. Other causes include:
- bowel obstruction with secondary perforation
- peptic ulcer disease
- endoscopic perforation
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