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Continuous diaphragm sign

Case contributed by Ian Bickle
Diagnosis certain

Presentation

Ingestion of batteries. Attended A and E.

Patient Data

Age: 25 years
Gender: Female
x-ray

Heart size normal.  Lungs clear.

No free subdiaphragmatic gas.

Six batteries projected over the body of the stomach in keeping with ingested foreign bodies.

D1 post endoscopic removal...

x-ray

D1 post endoscopic removal of gastric foreign bodies.

Large volume pneumoperitoneum with the continuous diaphragm sign.

Lungs clear.

Batteries no longer evident in the stomach.

Rigler sign.  Linear free gas beneath the inferior border of the liver.

Case Discussion

Ingestion of foreign bodies is commonplace.  Not all pass safely per rectum.

Retrieval is not without potential complication.

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