Demographics:
88 years old, Male
Indication:
Abdominal pain, ileus
Findings
- Large volume pneumoperitoneum, most evident in the right upper quadrant where there is a hyperlucent appearance of the liver and gas outlining the inner and outer margins of bowel loops (Rigler sign)
- Gaseous distension of the colon, most pronounced in the transverse colon
- Partially imaged large bowel-containing right inguinal hernia. A peripherally calcified structure immediately inferior to the right ischium likely represents a calcified peritoneal body within the hernia
- Gastrostomy tube overlies the left hemiabdomen
- Streaky bibasilar pulmonary opacities
- L1 vertebral body height loss
- Multilevel degenerative changes of the spine, most advanced at L4-L5
- Partially imaged median sternotomy changes
Diagnosis
Pneumoperitoneum
Inguinal hernia
Sample Report
Large volume pneumoperitoneum, which may be iatrogenic related to the gastrostomy tube, though hollow viscus perforation is not excluded. Consider CT for further evaluation.
Nonspecific gaseous distension of the colon. If there is concern for bowel obstruction, CT could provide further assessment.
Large, bowel-containing right inguinal hernia.
Streaky bibasilar pulmonary opacities, which likely represent atelectasis.
Age-indeterminate L1 vertebral body compression fracture.
Discussion