The Value of Lateral Decubitis Abdominal X-Ray in the Diagnosis of Perforation

A 72-year-old male home-care patient was admitted to our emergency department with complaint of decreased oral intake. His past history was notable for an unnamed muscle disorder, glaucoma and panic attack. Physical examination showed descreased bowel sounds and abdominal distention. The laboratory investigations showed an increased White Blood Cell count (32920 cells/ μl) and C-Reactive Protein level (270 mg/L). A lateral decubitis abdominal x-ray was performed due to immobilization of patient. A free air was observed in the x-ray (figure 1). Then, contrast-enhanced computed tomography was carried out and showed sigmoid colon perforation. In the study of Bansel et al. X-ray demonstrated pneumoperitoneum in 89.2% of 1723 patients and they said: ”Plain radiography is one of the first-line investigation technique, especially in developing countries where limited availability of resources” [1]. Moriwaki et al. determined bedside ultrasonography had sensitivity of 85% and a specificity of 100% in patients with serious abdominal pain and intraperitoneal free fluid [2]. Chiu et al. showed while erect chest radiograph had a sensitivity of 85.1%, left decubitus abdominal plain film had 98% in the diagnosis of free fluid [3]. Taking plain radiographs in the lateral decubitus position remains as one of the first-line diagnostic tests for immobile patients in emergency department.