Abstract
pentoneum. In the absence of a “benign” cause of pneumoperitoneum [1], the identification of free intraperitoneal gas usually indicates the need for emergency surgery to repair a perforated bowel. Because many patients with free bowel perforation are unable to cooperate for satisfactory radiography with a horizontal beam, it is incumbent upon the radiologist to recognize signs of pneumoperitoneum on the supine film [2]. We recently examined a patient with unsuspected colon perforation in whom detection of pneumoperitoneum on a supine abdominal radiograph was aided by visualization of the gallbladder, which was delineated by surrounding gas. This sign of pneumopentoneum is not mentioned in recent editions of two major textbooks of gastrointestinal radiology [3,4] or in a textbook on the abdominal plain film [5].
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