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Radiological Report - Standing AP Abdomen X-ray
Patient: Amaratbhai Parmar | 65Y | Male
Date: 17/07/2026 | 11:34 PM
View: Standing AP (Erect)
Institution: GMERS Civil General Hospital, Himmatnagar
Key Findings
1. FREE AIR (PNEUMOPERITONEUM) - CRITICAL FINDING
- Bilateral subdiaphragmatic free air: Large crescents of free gas are clearly visible beneath both hemidiaphragms (right and left sides)
- This is the most important finding on this film
2. HYDROPNEUMOPERITONEUM
- Massive, wide horizontal air-fluid levels spanning both upper quadrants - these are non-anatomical (not confined to bowel loops), extending freely across the peritoneal cavity
- The combination of free air + free intraperitoneal fluid constitutes hydropneumoperitoneum
- This is a surgical emergency
3. Bowel Gas Pattern
- Bowel loops are displaced downward and medially
- Some gas-filled loops visible in the mid-abdomen and left lower quadrant
- Normal bowel distribution is disrupted
4. Radiopaque Foreign Bodies
- Two small clip/staple-like metallic densities:
- One in the right iliac fossa/sacroiliac region
- One in the lower midline pelvis (just above pubic symphysis)
- Likely represent prior surgical clips (possibly previous hernia repair or pelvic surgery) - this is relevant history
5. Bony Findings (Incidental)
- Lumbar spondylosis: Marginal osteophytes, age-related degenerative changes
- Bilateral hip osteoarthritis: Mild subchondral sclerosis in both hip joints
- These are incidental and age-appropriate in a 65-year-old
Interpretation
DIAGNOSIS: PNEUMOPERITONEUM / HYDROPNEUMOPERITONEUM This is a surgical emergency. The bilateral subdiaphragmatic free air with non-anatomical horizontal air-fluid levels is the classic radiological sign of a perforated hollow viscus.
Differential diagnosis for the perforation:
| Cause | Notes |
|---|---|
| Perforated peptic ulcer (duodenal or gastric) | Most common cause in this age group |
| Perforated sigmoid diverticulitis | Common in elderly males |
| Perforated appendix | Less likely given age and bilateral free air |
| Perforated gastric/colonic malignancy | Must be excluded, especially at 65 years |
| Post-procedural perforation | Prior surgical clips noted - relevant history |
Clinical Correlation & Recommended Action
- Urgent surgical consultation - this film warrants immediate laparotomy/laparoscopy evaluation
- IV access, fluid resuscitation, broad-spectrum antibiotics immediately
- Nil by mouth
- CT abdomen with contrast (if patient is haemodynamically stable) - to localize the perforation site before surgery
- History of NSAID use, peptic ulcer disease, previous abdominal surgery (clips are present) should be sought urgently
⚠️ This is a time-sensitive finding. Mortality from hollow viscus perforation rises significantly with delay in surgical intervention.
This interpretation is based on radiological image analysis and is intended to support clinical decision-making. Final diagnosis must be correlated with full clinical history, examination, and further investigations by the treating surgical team.
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