Presentation
Presented with fever and abdominal pain. Ridgid abdomen on examination.
Patient Data
Centralized bowel loops with a large football shaped gas shadow beneath the anterior abdominal wall.
Large amount of free gas beneath the diaphragm with gas/fluid levels, indicating a larger amount of fluid in the peritoneal cavity.
Case Discussion
Free gas and fluid in the peritoneal cavity is due to a hollow viscus perforation.
The football sign requires a considerable amount of free gas to be identified on supine plain images.
At surgery, there were two 0.5 cm perforations in the terminal ileum and another area that would have perforated in a day or two. A large amount of fluid was aspirated from the peritoneal cavity. The patient required a small bowel resection, resuscitation and antibiotics. The appearance suggested a provisional cause of typhoid.
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