Authors: Maram Althagafi , Najeeb Alqarni , Bsaim Altirkistani

Abstract

Background: Gastrointestinal perforation with subsequent pneumoperitoneum is a life-threatening surgical emergency, has a high risk of morbidity and mortality, and requires prompt diagnosis and treatment. 

Case presentation: A four-year-old boy known case of lymphocele, tethered spinal cord syndrome, neurogenic bladder, and vesicoureteral reflux grade 3 was brought to the emergency department with a history of on and off periumbilical abdominal pain for 15 days, centralized in position, without radiation to other sites of abdomen, the pain became progressively severe in nature and intensity in the last three days. Point of care ultrasound was performed while waiting for the abdomen x-ray. The right upper quadrant of the abdomen was assessed using the curvilinear probe in the longitudinal view, which showed sonographic evidence of pneumoperitoneum, enhanced peritoneal stripe signs EPSS associated with posterior reverberation artifacts.

Conclusion: Understanding the fundamentals of abdominal ultrasound examination will give emergency physicians another diagnostic tool to identify life-threatening cases of acute pneumoperitoneum promptly.

Keywords: point of care, ultrasound, diagnosis, pneumoperitoneum, and pediatrics.