A 75 year old male presents in the early morning with a severe, generalized abdominal pain since 4 hrs. He describes having had some cramplike abdominal pain and bilious vomiting yesterday. His medical history includes hypertension, ischemic heart disease, COPD, and gout. His abdomen is mildly distended, without visible scars, and there is no discoloration of the skin. radiographs attached. commenty on Dx and treatment plan.

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With given history and x ray it is a case of hollow viscera perforation

Free gas under domes of diaphragm. Perforation.

Hollow viscus perforation with paralytic ilieus Adv ct abd

Sigmoid volvulous.ct abd. Emergency laparotomy.

Perforation peritonitis,exp.laparotomy advised

Air under diaphram. Int. Perforation.

Perforation..

I go with Dr R Chitroptpala

Gas under domes of diaphragm. Large hollow viscous perforation. Surgical Emergency.

Perforation peritonitis with paralytic ileus.

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