Causes

• Most common: Perforated bowel due to peptic ulcer disease or instrumentation or surgery (laparotomy)
• diverticulum perforation

PC

• Abdominal pain
• nausea, vomiting
• laying still

Examination:

• Guarding
• rebound tenderness

Investigations

Bedside - ECG (prior to general anaesthetic)

Labs - ABG

Imaging:

• CXR more sensitive then AXR
• AXR - The Rigler sign, also known as the double-wall sign, is a sign of pneumoperitoneum seen on an abdominal radiograph when gas is outlining both sides of the bowel wall, i.e. gas within the bowel's lumen and gas within the peritoneal cavity. It is seen with large amounts of pneumoperitoneum (>1000 mL).
• If identified - CT abdo