Pneumoperitoneum: an alarming sign of a life-threatening diagnosis

Abstract

An 81-year-old man presented to the emergency room with a large, incarcerated umbilical hernia. He underwent an emergent umbilical hernia reduction and surgical repair. On postoperative day 5, the patient presented with tachypnea, tachycardia, hypotension, and abdominal distention. Chest X-ray showed air under the diaphragm. Clinical findings were highly suggestive of bowel perforation, for which the patient underwent emergent exploratory laparotomy and enterorrhaphy. Bowel perforation is a surgical emergency associated with a high mortality rate. Plain radiograph (standing chest X-ray) is a rapidly accessible and sensitive tool that may help identify even a small amount of gas within the peritoneal cavity suggestive of bowel perforation.