Free air under diaphragm means
air seen on simple chest x-ray taken in the erect position (standing or upright
position) of the patient. As per medical joke, it is not ‘free air’, it costs a
lot or results expensive. For this free air under diaphragm, immediate surgical
intervention (mostly exploratory laprotomy) is indicated. And, this is so
called ‘free air’ that causes the poor patient to undergo a big operation
(exploratory laprotomy).
Most of the time, the cause of
this free air under diaphragm is the perforated abdominal viscus. It means free
air itself is not fatal, but the factual reason behind it is dangerous as along
with the free air leaking out enteric content is deadly. Perforation of stomach
or duodenum happens to occur due to peptic ulcers that leak out. Perforation of
small intestine is less common and may result from inflammatory conditions like
Crohn’s disease or cancers. However, perforation of colon is relatively more
common and it may result from diverticulitis.
In nutshell, the differential
diagnosis of air under diaphragm is as follows:
- Perforated peptic ulcer (most common)
- Ruptured diverticulitis (colon)
- Abdominal trauma
- Perforated cancer (colon)
- Esophageal tear (Boerhaave's syndrome)
- Perforated cancer of stomach
- Abdominal instrumentation
Again a medical joke, you call it
free air while it is under the diaphragm. It means that there are not two or
three air bubbles but a large collection of air under diaphragm.
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