MCQ – 86415

All of the following could be the cause of the following X-ray finding except

–

A.	Duodenal ulcer perforation
B.	Post laparoscopy
C.	Chilaiditi syndrome
D.	Acute intestinal obstruction

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Correct Answer � D Explanation

Ans.D.  Acute intestinal obstruction

The X-ray is characteristic of Pneumoperitoneum which is not seen in Acute intestinal obstruction.

• The erect X-ray shows gas under both the diaphragms, and the most important cause for this is a hollow viscus perforation.

• An intestinal obstruction would show multiple dilated loops on X-ray with possible air-fluid levels. Only when the obstruction becomes severe and there is a perforation, pneumoperitoneum occurs.

Causes other than perforation are:

• Chilaiditi syndrome (where the intestine is seen between the liver and diaphragm giving a false impression of free air).

• Subphrenic abscess.

• Postoperatively air may be present in the abdomen up to 7 days.

Other signs in pneumoperitoneum:

1. Rigler’s sign: The outer and inner walls of the bowel loop are delineated by gas.

2. Football sign/ Air dome sign: A central round air collection seen on a supine X-ray.

3. Inverted V sign: Gas is seen on either side of the umbilical ligament.

Note: In an emergency setting, where a patient presents with peritonitis and Xray abdomen confirming pneumoperitoneum, an emergency laparotomy is undertaken to manage the bowel perforation.