This is a 26 year white male medical student who presented to the ED with intense abdominal pain lasting 12 hours. He is experiencing epigastric pain increasing in intensity and diffuse pain throught the abdomen. This pain is not relieved with mylanta or Pepcid. This chest film demonstrates free air under the right hemidiaphragm. The remainder of the chest film is normal. The patient was taken to the OR and an exporatory laparotomy was performed due to the physical exam finding of an acute abdomen. A perforated duodenal ulcer was found and repaired.
The radiographic evaluation of an acute abdomen includes an upright CXR. This should be examined for pneumonia and free air under the diaphragm. If the patient is unable to stand or sit up a left lateral decubitus film should be taken. Free air will show up lateral to the liver. A KUB could show obstructive gas pattern (air fluid levels), ileus, free air or air in the biliary tree, or mass effect. An ultrasound can aid in the visualization of the hepatobiliary tree, pancreas, vascular structures, kidneys, pelvic organs, and fluid collections. A CT can also be helpful. An upper GI or a lower GI can demonstrate a perforation if water soluble contrast is used. An IVP can be used to demonstrate ureter stone or obstruction.