Pneumoperitoneum - iatrogenic

Case contributed by Dr Yair Glick


Sigmoid colon perforation 30 cm from anal verge at elective colonoscopy. Asymptomatic.

Patient Data

Age: 70 years
Gender: Male

Scout view


Scout view: Large amount of pneumoperitoneum, roughly oval in shape, with outlined falciform ligament giving the appearances of football sign and falciform ligament sign.

Lucent right paravertebral streak from L1/L2 to S1 - pneumoretroperitoneum?

Streaks of gas in the pelvis.

Surgical clips projected over the sigmoid colon.

Massive pneumoperitoneum with falciform ligament sign.

Moderate amount of right pneumoretroperitoneum.

Diverticulosis of the sigmoid and descending colon.

Surgical clips in the mid-sigmoid colon.

Sternotomy closure wire noticed.

Case Discussion

A patient with left-sided colonic diverticulosis was referred to CT abdomen for assessment of intra-abdominal free air following accidental perforation of his sigmoid colon at colonoscopy.

The football sign is clearly seen on the scout view.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.