Small-bowel obstruction and perforation leading to peritonitis.
Supine abdominal X-ray shows a large volume of free air in the peritoneal cavity, together with a large volume of fluid, the fluid margin being indicated in both flanks by the larger arrows. There is considerable gaseous distension of the small-bowel loops and one loop is distended entirely by fluid (F). Gas is seen on both sides of the bowel wall (between small arrows), which is a sign of pneumoperitoneum. There is also evidence of slight thickening of the small-bowel wall. At laparotomy, pneumoperitoneum and peritonitis were confirmed, resulting from a small-bowel perforation. The patient had had previous radiotherapy for a colonic carcinoma and had extensive small-bowel radiation damage and adhesion formation, leading to partial obstruction.
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