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Free Air in the Abdomen

The Common Vein Copyright 2008

Definition

Free air in the abdomen is a mechanical complication of a perforated hollow viscus such as the colon, stomach or duodenum.  The causes for the perforation are numerous and include iatrogenic causes, ischemia, obstructions, penetrating ulcers, and malignancies of the bowel wall for example.  Colonic perforations usually result in the largest volumes of air.

The diagnosis must be considered in every patient with an acute abdomen since the finding of free air inevitably implies a surgical disease.  It is best and most inexpensively made omn the upright abdomen while it may be suspected on the supine examination as well. CTscan can diagnose small amounts of air.

Treatment is usually surgical

 

28088
28088 abdominal pain fx free air in the abdomen peritoneal cavity dx giant diverticulum dx rupture of diverticulum CXR chest plain film upright Courtesy Ashley Davidoff MD 28087 28088 28090

30256
This plain film of the chest is a classical ICU film where the overlying paraphernalia cause one to focus only on the chest. In this instance however, the free air under each of the hemidiaphragms is difficult to miss. Courtesy Ashley Davidoff MD.

24172
24172 24171 71F with diffuse abdominal pain liver colon large bowel abdomen peritoneal cavity hepatic lucency fx lucent RUQ fx free air dx perforated viscus probably colonic perforation of colon plain film Courtesy Ashley Davidoff MD radiologists and detectives emergency 5star

24173
24173 71F with diffuse abdominal pain liver colon large bowel abdomen peritoneal cavity hepatic lucency fx lucent RUQ fx free air dx perforated viscus probably colonic perforation of colon plain film Courtesy Ashley Davidoff MD radiologists and detectives emergency 5star CTscan Courtesy Ashley Davidoff MD

24175
24175 71F with diffuse abdominal pain colon large bowel abdomen peritoneal cavity fx clarity of bowel wall fx Rigler’s sign Riglers sign fx free air dx perforated viscus probably colonic perforation of colon plain film Courtesy Ashley Davidoff MD radiologists and detectives 5star

24178
24178 24175 71F with diffuse abdominal pain colon large bowel abdomen peritoneal cavity fx clarity of bowel wall fx Rigler’s sign Riglers sign fx free air dx perforated viscus probably colonic perforation of colon CTscan Courtesy Ashley Davidoff MD radiologists and detectives 5star

43359
43359 hx 64F with acute abdomen – abdominal pain code duodenum fx free contrast spillage fx free air fx thickened wall dx perforated duodenal ulcer CTscan Courtesy Ashley Davidoff MD

25178
25178 Hx M65 small bowel jejunum fx diverticulum fx free air dx perforation imaging radiology CTscan Courtesy Ashley Davidoff MD DB

16510
16510 colon + dx trauma + fx free air + fluid + imaging radiology CTscan radiologists and detectives note glass in soft tissues

45763
45761 45763 hx elderly male with question free air abdomen colon liver fx anterior and superior location and position of the hepatic flexure below the diaphragm dx Chilaiditi syndrome interposition of large bowel between liver and anterior abdominal wall normal variant CTscan Courtesy Ashley Davidoff MD 45758 45761 45763 45764 45765 45767 45768

45767
45767 hx elderly male with question free air abdomen colon liver fx anterior and superior location and position of the hepatic flexure below the diaphragm dx Chilaiditi syndrome interposition of large bowel between liver and anterior abdominal wall normal variant CTscan 45758 45761 45763 45764 45765 45767 45768

45763
45761 72797.800 hx elderly male with question free air abdomen colon liver fx anterior and superior location and position of the hepatic flexure below the diaphragm dx Chilaiditi syndrome interposition of large bowel between liver and anterior abdominal wall normal variant CTscan Courtesy Ashley Davidoff MD 45758 45761 45763 45764 45765 45767 45768