- Etiology: placement of a gastrojejunostomy tube, use of indomethacin to close a patent ductus arteriosus, bowel atresia, ischemic necrosis, blunt trauma
- CXR upright – air beneath the diaphragm
- AXR upright – air beneath the diaphragmAXR left lateral decubitus: air above the liver (air between abdominal wall and liver)
- AXR cross-table lateral: for small amounts of free air see tell-tale triangle sign of air between bowel loops, for large amounts of free air see air superiorly between abdominal wall and viscera
- AXR supine: overall increased lucency of abdomen, American football sign of falciform ligament, inverted Y of umbilical artery ligaments, Rigler’s sign (see air outlining both sides of bowel wall)
- Note: in inflamed abdomen (due to perforation), pneumoperitoneum may be loculated and not be classically seen on upright / decubitus / cross-table lateral views, may appear as fixed air collection that does not appear to conform to bowel
Radiology Cases of Small Bowel Perforation




Surgery Cases of Small Bowel Perforation
