Free Gas Under The Diaphragm in a Plain X Ray
Causes
1. Perforation of a Hollow viscous- Gastric/Duodenal/Ileal ( Peptic ulcer Disease,/Typhoid/Crohn’s/Malignancy)
2.Penetrating injury Abdomen
3.Following Laparoscopic procedure
4.Following Tubal Insufflation Test
5.Infection with gas forming organisms
6.Most common cause of free gas under the Diaphragm is -Laparotomyor post operative patients.
7.Chilaiditi's sign-due to interposition of colon between the Diaphragm and the Liver such a gas shadow can be obtained even in a normal individual.
Most common cause of pneumoperitoneum is no doubt, laparotomy. Post operative xray is indicated very rarely and hence we shall not consider it as a cause. Following laparoscopic procedure, pneumoperitoneum is unlikely as CO2 is absorbed rapidly from the peritoneum unlike nitrogen.
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