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Pneumoperitoneum

Case contributed by Jose Ignacio Aragon
Diagnosis certain

Presentation

Post-laparoscopy check up.

Patient Data

Age: 45 years
Gender: Male
x-ray

Crescent-shaped band of gas between the liver and the diaphragm.

Bicameral pacemaker.

Case Discussion

Pneumoperitoneum is defined by the presence of free gas within the peritoneal cavity.

In the context of abdominal pain, this could be a sign of bowel perforation, most commonly duodenal or gastric ulcer perforation. Additional causes include recent surgery, trauma, and infection of the peritoneal cavity with gas producing organisms.

Upright chest radiographs are the most sensitive for detecting the presence of pneumoperitoneum. However, in very ill patients crosstable lateral and left lateral decubitus views could be useful to demonstrate the free air outlining the liver.

Case courtesy of Dr Jose R Zuniga.

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