Detection of pneumoperitoneum: optimum body position and respiratory phase

Abnormal intraabdominal gas collections visualized on computed tomography: A clinical and experimental study

“…Miller and Nelson [23] and Miller et al [24] were able to detect as little as 1-cc of intraabdominal air on conventional radiographs in humans. The failure to identify a l-cc collection in a rabbit is probably due to the difficulty in handling and imaging small animals.…”

Pneumoperitoneum after percutaneous endoscopic gastrostomy: A case report and review

“…In a recent study by Nielsen et al, PP discovered after open abdominal surgery typically resolved within 2 days and only one patient in their study had radiographic evidence of PP at 5 days (19). The degree and duration of PP may be affected by body habitus, with thin people tending to have more free air and the longest duration of PP (8,20). The fact that a thin body habitus did correlate with ease of finding free air on X-ray study, but did not correlate with finding free air on CT scan, suggests that obesity simply makes it more difficult to see free air on an X-ray study (21).…”

“…For practical purposes, however, plain X-ray studies are adequate for detection of small amounts of free air and can be improved by proper technique. An upright chest X-ray, preferably after the patient has been upright for 5-10 min, with the central ray of the X-ray beam at the highest level of the peritoneal cavity, is considered the best initial study (20). Placement of the patient in the left lateral decubitus position for 10 to 20 min before mid-inspiratory and expiratory radiographs may improve sensitivity of the study in some subjects (20).…”

“…An upright chest X-ray, preferably after the patient has been upright for 5-10 min, with the central ray of the X-ray beam at the highest level of the peritoneal cavity, is considered the best initial study (20). Placement of the patient in the left lateral decubitus position for 10 to 20 min before mid-inspiratory and expiratory radiographs may improve sensitivity of the study in some subjects (20). Due to different exposure techniques, plain upright chest radiographs are often more sensitive in detecting free air than abdominal films (20).…”

“…Placement of the patient in the left lateral decubitus position for 10 to 20 min before mid-inspiratory and expiratory radiographs may improve sensitivity of the study in some subjects (20). Due to different exposure techniques, plain upright chest radiographs are often more sensitive in detecting free air than abdominal films (20).…”