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Non-surgical causes of pneumoperitoneum—characteristic ‘Rigler's sign’ in a chest x-ray due to pneumothorax with a diaphragmatic hernia
  1. Frances Dockery1,
  2. Marc George2,
  3. Suchitra Chinthapalli1
  1. 1Deparment of Ageing and Health, St Thomas' Hospital, London, UK
  2. 2Deparment of Orthopaedics, St Thomas' hospital, London, UK
  1. Correspondence to Dr Frances Dockery, St Thomas' Hospital, Department of Ageing and Health, Westminster Bridge Road London, London SE1 7EH, UK; frances.dockery{at}

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Rigler's sign is a radiological sign of free intraperitoneal air, generally from a perforated viscus. It is the appearance of air on both sides of the bowel wall due to a large quantity of free air in the abdomen. It is important to be aware of the non-surgical causes of this appearance, one of which we describe here.

An 87-year-old man whose only medical history was of a long-standing, seemingly asymptomatic, diaphagramatic hernia (figure 1, preoperative film), underwent a total hip replacement with …

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  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.