Detecting Pneumoperitoneum via Point-of-Care Abdominal Ultrasound: To See Beyond Touch

Point-of-care ultrasound is increasingly important in the management of acute medical emergencies. An elderly man was brought to the emergency department after 2 days of fever and urinary retention. He was drowsy and had peri-arrest arrhythmia. He was hypoperfused peripherally with a systolic blood pressure of 45 mmHg and so was managed as for septic shock with no obvious aetiology. Chest and abdominal physical examinations were unremarkable. The source of sepsis was unclear. A point-of-care abdominal ultrasound was performed by the reviewing internist which detected a pneumoperitoneum, leading to a change in diagnosis to a perforated viscus which was confirmed later by a CT of the abdomen and pelvis