Annals of Medicine and Surgery 3 (2014) 111e112
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Annals of Medicine and Surgery
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Grand round A 50 year old man with acute abdominal pain
* Sukhpreet Singh Dubb a, Joanna M. Farrant b, B.V. Praveen c, Sascha Miles-Dua c, a Broomfield Hospital, Essex, United Kingdom b Imperial College London, United Kingdom c Southend Hospital, Essex, United Kingdom article info
Article history: beats per minute. He has generalised tenderness of the abdomen, Received 25 June 2014 guarding and absent bowel sounds. This is his abdominal x ray. Accepted 26 June 2014 What is the most likely diagnosis?
Keywords: A Perforated sigmoid diverticulae Acute abdominal pain B Perforated peptic ulcer CXR Perforated peptic ulcer C Spontaneous bacterial peritonitis
The correct answer is B. The most likely cause of the pneumoperitoneum is a perforated peptic ulcer. This patient has a history of indigestion and takes regular anti inflammatory drugs. The supine x-ray of the abdomen You see a fifty year old man in the emergency department. He has shows normal gas in the bowel and free air outside of the bowel. had worsening abdominal pain for the last twenty four hours. He has This is known as Rigler's sign. arthritis and takes regular anti inflammatory drugs. He tells you that Rigler's sign is usually seen when there is more than one the tablets cause indigestion but that he needs to take them for the thousand mls of free gas and fluid in the peritoneum. There is also a arthritis. On examination he is lying very still. His heart rate is 120 pocket of air in the right iliac fossa between the loops of bowel. This is why the following answers are incorrect. A. There is no history of diverticular disease in this patient. This patient has a history of indigestion and takes regular anti inflam- matory drugs. The most likely cause is a perforated peptic ulcer. C. Free intraperitoneal gas is the striking feature on this X-ray, which is not characteristic of spontaneous bacterial peritonitis.
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