Question
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| A. | Duodenal ulcer perforation |
| B. |
Post laparoscopy |
| C. |
Chilaiditi syndrome |
| D. |
Acute intestinal obstruction |
|
Correct Answer � D Explanation |
 |
Ans.D. Acute intestinal obstruction
The X-ray is characteristic of Pneumoperitoneum which is not seen in Acute intestinal obstruction.
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The erect X-ray shows gas under both the diaphragms, and the most important cause for this is a hollow viscus perforation.
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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:
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Chilaiditi syndrome (where the intestine is seen between the liver and diaphragm giving a false impression of free air).
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Subphrenic abscess.
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Postoperatively air may be present in the abdomen up to 7 days.
Other signs in pneumoperitoneum:
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Rigler’s sign: The outer and inner walls of the bowel loop are delineated by gas.
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Football sign/ Air dome sign: A central round air collection seen on a supine X-ray.
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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.