2. INTRODUCTION:
Pneumoperitoneum refers to the presence of free
gas within the peritoneal cavity. The plain films
signs of pneumoperitoneum are both diverse and
sometimes difficult to identify.
Pneumoperitoneum is most often caused by
perforated abdominal viscus and can present an
acute medical emergency.
3.
4. “The Radiological signs of pneumoperitoneum
are among the most important signs in
radiology, indeed in Medicine. Sometimes the
amount of free gas is small and you may have
to work to demonstrate it (i.e. modify the film
technique). Miss it and the patient may die”
12. A 51-year-old man presented to the ED with progressive
abdominal pain of one day's duration. He had not
eaten all day and had vomited twice. There was no
associated diarrhea or melena.
He had a history of alcoholic hepatitis, COPD, and
surgical repair of a colonic-bladder fistula 10 years
earlier. He had mild constipation and abdominal
discomfort for the past few months.
On examination, the patient was in moderate distress
due to abdominal pain. Vital signs: blood pressure
130/70 mm Hg; pulse 118 beats/min; respirations 24
breaths/min; temperature 100.8º F (rectal).
His abdomen was distended but soft, with mild diffuse
tenderness and no rebound tenderness. His stool was
negative for occult blood. He was anicteric
13.
14. The best radiographic view for detecting free
intraperitoneal air is the upright chest radiograph
15.
16.
17.
18.
19.
20. Look 4 air
• Anterior subhepatic space free air
• Morrison’s pouch
• Air anterior to ventral surface of liver
• Decubitus abdomen sign
• Rigler’s sign on supine
• Falciforme ligament sign
• The “football “signe Air
21. • Continuous Diaphragm sign
• Double bubble sign
• The Cupola sign
• Lesser sac gas
• The triangle sign
• Pneumoretroperitoneum
