Pneumoperitoneum

JOURNAL READING
Pneumoperitoneum: What to look for in a radiograph?

Binit Sureka1, Kalpana Bansal1, Ankur Arora1
1)Department of Radiology and Interventional Radiology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India
Kelompok :
Asy Syadzali
F. Dea Chika Putri
Muhammad Dimas Pangestu
Nur Azizah
Pembimbing :
dr. Rasyidah, Sp. Rad
BAGIAN ILMU RADIOLOGI

FAKULTAS KEDOKTERAN UNIVERSITAS LAMPUNG
RUMAH SAKIT UMUM DAERAH Dr. H. ABDUL MOELOEK
BANDAR LAMPUNG
2019
Pneumoperitoneum
It is usually
detected on x-ray,
but small amounts
of free peritoneal The most common
Pneumoperitoneum cause of a
is the presence of air air may be missed
pneumoperitoneum The causes of
or gas in the and are often is a perforation/
detected on pneumoperitoneum occurring
abdominal disruption of the in children are different from
(peritoneal) cavity. computerized wall of a hollow
tomography (CT). viscus. the adult population.
Erect Chest X-Ray
An erect chest x-ray is the most sensitive

plain radiograph for the detection of free
intraperitoneal gas in an emergency setting.
On chest x-ray, any subdiaphragmatic free

gas can be seen. b)
a)
a) X-ray of abdomen, erect view, showing subdiaphragmatic free

air (white arrows), air outlining the properitoneal fat stripe
(black arrows)
(b) Cupola sign (arrowheads)
(c) Rigler’s sign (arrow)
(d) Chest radiograph showing free air under the diaphragms
(arrowhead) c
c) d
d)
The Various Signs in an Abdominal Radiograph
1. Cupola/saddlebag/mustache sign — Seen on a supine

radiograph, refers to air accumulation underneath the central
tendon of the diaphragm in the midline.
2. Rigler’s sign — Air outlining both sides of the bowel wall.
3. Lucent liver sign — Reduction of liver opacity due to air located

anterior to the liver.
4. Football sign — Seen in massive pneumoperitoneum, where the

abdominal cavity is outlined by gas.
The Various Signs in an Abdominal Radiograph
5. Silver’s Sign — Also called a falciform ligament sign, where
air outlines the falciform ligament.
6. Inverted V sign — Air outlining lateral umbilical ligaments

(inferior epigastric vessels).
7. Doge’s cap sign — Triangular collection of gas in Morison

pouch.
8. Telltale triangle sign — Triangular air pocket between

three loops of bowel.
9. Urachus sign — Outline of middle umbilical ligament.

Causes of Pneumoperitoneum
A gastrointestinal perforation constitutes one of the
commonest surgical emergencies.
The causes of pneumoperitoneum in adults are

perforation, peritoneal dialysis, immediate
postoperative status, vaginal aspiration, and
mechanical ventilation.
The causes of pneumoperitoneum in children are

perforation (necrotizing enterocolitis, Hirschsprung’s
disease, and meconium ileus) and iatrogenic effects,
such as from use of rectal thermometer, enema, and
postintubation or mechanical ventilation.
Causes of Perforation Peritonitis
Bali et al. in their study of 400 patients found

that the commonest cause of perforation
peritonitis in their study was :
- acid peptic disease (45%), followed by
- appendicitis (18.5%),
- typhoid fever (12%),
- tuberculosis (10%), and
- trauma (9%).
Signs & Symptomps
Common signs and symptoms are
- abdominal pain,
- vomiting,
- abdominal distension,
- constipation,
- fever,
- diarrhea,
- tachycardia (pulse >110/min),
- hypotension (systolic blood pressure <100mmHg),
- urine output (<30 mL/h), and
- tachypnea (respiratory rate >20/min).
Pseudopneumoperitoneum
Pseudopneumoperitoneum describes gas within

the abdomen that mimics pneumoperitoneum.
The various causes of

pseudopneumoperitoneum are :
-basal linear atelectasis,
-pneumomediastinum,
-Chilaiditi syndrome,
-gas within skin folds,
-subdiaphragmatic lipomatosis,
-properitoneal fat stripe, and
-diaphragmatic undulations.
P Problem
Apa yang harus dicari dalam radiografi
pada pneumoperitoneum?
Pneumoperitoneum adalah adanya udara
PICO I Intervention
atau gas di rongga perut (peritoneal)
biasanya terdeteksi pada X-Ray.
Tidak ada intervensi
C Comparison
Membandingkan penyebab pneumoperitoneum pada pasien anak dan
dewasa.
O Outcome
Rontgen dada tegak adalah radiografi polos paling sensitif untuk mendeteksi gas
intraperitoneal gratis dalam keadaan darurat.
VIA
Validity
Jurnal “Pneumoperitoneum: What to look for in a radiograph?

” diterbitkan Department of Radiology and Interventional Radiology, Institute of Liver
and Biliary Sciences (ILBS), New Delhi, India.
Diterbitkan Juli 2015

DOI : 10.4103/2249-4863.161369
VIA
Importancy
Penelitian ini menjelaskan tanda-tanda relevan yang harus dicari dalam radiografi
pada pneumoperitoneum. Rontgen dada tegak adalah radiografi polos paling sensitif
untuk mendeteksi gas intraperitoneal bebas dalam keadaan darurat. Penyebab paling
umum dari pneumoiperitoneum adalah perforasi atau gangguan dinding viskus
berongga.
VIA
Applicability
Penerapan jurnal ini dapat digunakan dalam hal:

Diagnosis objektif pneumoperitoneum pada pasien dewasa dan anak dapat dideteksi
menggunakan pemeriksaan radiografi rontgen dada tegak (erect chest X-ray) yang
akan menunjukkan adanya gas intraperitoneal bebas dalam keadaan darurat.
T E R I M A
K A S I H

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JOURNAL READING

Pneumoperitoneum: What to look for in a radiograph?

BAGIAN ILMU RADIOLOGI

An erect chest x-ray is the most sensitive

On chest x-ray, any subdiaphragmatic free

a) X-ray of abdomen, erect view, showing subdiaphragmatic free

1. Cupola/saddlebag/mustache sign — Seen on a supine

2. Rigler’s sign — Air outlining both sides of the bowel wall.

3. Lucent liver sign — Reduction of liver opacity due to air located

4. Football sign — Seen in massive pneumoperitoneum, where the

6. Inverted V sign — Air outlining lateral umbilical ligaments

7. Doge’s cap sign — Triangular collection of gas in Morison

8. Telltale triangle sign — Triangular air pocket between

9. Urachus sign — Outline of middle umbilical ligament.

The causes of pneumoperitoneum in adults are

The causes of pneumoperitoneum in children are

Bali et al. in their study of 400 patients found

Pseudopneumoperitoneum describes gas within

The various causes of

Jurnal “Pneumoperitoneum: What to look for in a radiograph?

Diterbitkan Juli 2015

Penerapan jurnal ini dapat digunakan dalam hal:

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