Sonographic Diagnosis of Pneumoperitoneum: An Underused Examination Modality

Pneumoperitoneum secondary to perforated viscus is a commonly encountered diagnosis within Emergency Medicine and General Surgery. Plain radiographs and computed tomography are considered the gold standard for diagnosis. However, such investigations may not be possible if the patient is too unstable, or due to resource limitations. In this study, we report a case of pneumoperitoneum diagnosed with point-of-care ultrasound, without relying on the aforementioned gold standard investigations.

A 50-year-old Chinese man presented to our Emergency Department with severe epigastric pain. Full physical examination and conventional plain radiography were not feasible due to the patient’s distress. Point-of-care ultrasound was used to diagnose pneumoperitoneum, which was later confirmed with a CT scan after admission to the Surgical unit.

Therefore, the authors believe that point-of-care abdominal ultrasonography is a useful tool in diagnosing pneumoperitoneum. However, due to the lack of high-level evidence, it is currently unclear if this should be considered a routine examination in patients presenting with acute abdomen.

Keywords: PoCUS, Emergency Medicine, Ultrasonography, Pneumoperitoneum, Abdominal Pain.