IMAGES IN EMERGENCY MEDICINE
Rigler’s sign in a patient with massive pneumoperitoneum
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
Correspondence to:
Correspondence to:
S Milanchi
Cedars-Sinai Medical Center, Department of Surgery, 8700 Beverly blvd, Los Angeles, California 90048, USA; smilanchi@yahoo.com
Accepted 28 June 2006
| The first 150 words of the full text of this article appear below. |
Rigler’s sign (double-wall sign) was first described by Leo George Rigler (American radiologist, 1896–1979) in 1941. This is a radiographical sign of massive pneumoperitoneum. In massive pneumoperitoneum, abdominal radiography shows that the bowel wall is outlined by air both inside and outside. This manuscript presents a case of massive pneumoperitoneum secondary to perforation of the colon.
An 80-year-old man presented to the emergency room with abdominal pain and distension, nausea and vomiting for 1 week. He had constipation for 5 days before the onset of these symptoms. His abdomen was distended, tense and tympanic with tenderness of all quadrants. Abdominal radiography showed extensive pneumoperitoneum and Rigler’s sign (double-wall sign1).
Exploratory laparotomy showed a small perforation of the caecum. A limited right colectomy with primary anastomosis was carried out.
Histopathology showed areas of colitis with focal ulceration and thinning, and atrophy of the muscularis propria of the caecum with perforation,
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