60 years old male with complaint of abdominal distension and guarding and rigidity present.. spot the diagnosis...

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Thin crescentic translucency under rt some of diaphragm s/o pneumoperitoneum Multiple abnormal air fluid levels in step ladder appearance s/o sbo Properitoneal fat planes are distended and haziness in abdomen s/o ascites

Gas under Rt dome of diaphragm present, hence it is a case of peptic perforation, advised immediate operation & closure of perforation

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Gas under diaphragm below rt dome of diaphragm, as the pneumo layer is thin chance of DU perforation is less could be a small bowel perforation mostly in terminal part, any history of fever in last three weeks, large bowel is not visualized so there is small bowel obstruction then perforation. After resuscitation he required emergency exploration..

air under diaphragm present on rt side.? hollow viscous perforation. signs of peritonitis present. midline laparotomy and proceed.alternatively lap exploration and proceed. no chance of chelladiti syndrome as fluid levels and signs of peritonitis r present.

Multiple gas and fluid levels with pneumoperitoneum suggestive of Intestinal Obstruction with peritonitis Exploratory laprotomy and proceed is recommended

It is a case of Intestinal obstruction with perforation as there is Gas under Rt dome of diaphragm REQIRES Emergency Laparotomy after assessing general conditions

2 things are noted in this X Ray one is Gas under right dome of diaphragm indicating hollow viscus perforation the culprit could be gastric ulcer ;duodenal ulcer ; ischemic bowel disease; diverticulitis ; typhoid perforation of the ileum . 2nd ...multiple air fluid level centrally placed indicating of small bowel obstruction.... indicators of peritonitis causing adynamic obstruction or can even be because of dynamic obstruction due to the intestine getting entangled in pus and collection in the pelvis.

Gut perforation with peritonitis.Features of obstruction may be due to paralytic ileus.
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perforation peritinitis

The re is Gas under the Rt dome of the diaphragm with gas distended loops of Intestines So it is a case of Perforation with Peritonitis

The re is Gas under the Rt dome of the diaphragm with gas distended loops of Intestines So it is a case of Perforation with Peritonitis

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