Pneumoperitoneum

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Pneumoperitoneum
Pneumoperitoneum.jpg
Frontal chest X-ray. The air bubble below the right hemidiaphragm (on the left of the image) is a pneumoperitoneum.
ICD-10 K66.8
ICD-9 568.89, 770.2
DiseasesDB 31511
eMedicine radio/562 
MeSH D011027

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Pneumoperitoneum is air or gas in the abdominal (peritoneal) cavity[1], often seen on x-ray, but small amounts are often missed and CT is nowadays regarded as a criterion standard in the assessment of a pneumoperitoneum.[2].

Causes

The most common cause is a perforated abdominal viscus, generally a perforated ulcer, although any part of the bowel may perforate from a benign ulcer, tumor or trauma. A perforated appendix seldom causes a pneumoperitoneum. A pneumoperitoneum is deliberately created by the surgical team in order to perform laparoscopic surgery. This is achieved by insufflating the abdomen with carbon dioxide.

Subphrenic abscess, bowel interposed between diaphragm and liver (Chilaiditi syndrome), and linear atelectasis at the base of the lungs can simulate free air under the diaphragm on a chest x-ray.

Diagnosis

Chest X-ray

Plain film signs of pneumoperitoneum

  • Rigler's sign (gas outlining both mucosal and serosal surfaces of bowel wall)
  • Falciform ligament sign (gas outlining the falciform ligament)
  • Football sign (gas outlining the peritoneal cavity)

CT

CT can visualize quantities as small as 5 cm³ of air or gas.

See also

References


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