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Pneumoperitoneum

Case contributed by Frank Gaillard
Diagnosis certain

Presentation

Presented with severe central chest pain.

Patient Data

Age: 50 years
Gender: Female

CXR

x-ray

Extensive free gas below the diaphragms. Lungs are clear.

Annotated image

Annotated image

A large amount of gas is seen under both diaphragmatic domes (yellow dotted lines). In the left upper quadrant gas is also seen in the stomach (red dotted line) and splenic flexure of the colon (blue dotted line). 

Case Discussion

This patient did have a CT which demonstrated extensive sigmoid diverticular disease with active inflammation and diverticulitis, accounting for the pneumoperitoneum.  Conservative treatment was followed by sigmoidoscopy for direct visualiation.

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