Submitted on 30 May 2009
A patient with known congestive heart failure and mild renal impairment was admitted to the orthopedics ward for left hip traumatic fracture. Because of persistent heart failure, operation was delayed for the sake of optimization of cardiovascular system. On the 7th day of admission, he complained of abdominal pain and increasing SOB. There was no guarding on abdominal palpation, but bowel sound was sluggish. Temperature 38.5 degree. ABG showed pH 7.27, pCO2 of 28 mmHg, pO2 67 mmHg, BE -13. Presumptive diagnosis of abdominal sepsis was made. While he was waiting for CT abdomen, this abdomonial x-ray was taken. After seeing the film, the attending clinician cancelled the CT appointment and requested urgent laparotomy with post-op ICU bed.
The above film shows a famous x-ray sign. What is it?
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Following signs are seen:
(A) Small gas collection in lesser sac
(B) Falciform ligament sign
(C) Periduodenal gas pocket at junction of first and second part of duodenum
Don’t miss the large parahepatic gas lateral to the liver edge.
Diagnosis: perforated duodenum with huge free peritoneal gas