Gas
under diaphragm is synonym with pneumoperitoneum which could be due to many
reason. Most of it are due to perforated viscus. Apart from that, other
condition may also occurs. Therefore, correct history taking and good physical
examination may aid in making a diagnosis.
Differential
diagnosis for gas under diaphragm includes.
1)
Perforated viscus.
a)
GI Malignancies
b)
Perforated ulceration of GI Tract
c)
Typhoid
d)
Tuberculosis
e)
Ulcerative Colitis
f)
Foreign body
g)
Inflammation
h)
Diverticulum
1)
Trauma
j)
Intestinal obstruction
2)
Subphrenic abscess with gas
3)
Intra abdominal abscess with gas forming organism.
4)
Transposition of viscera
eg
Chilaiditi syndrome (Interposition of the colon and the liver below the right
hemidiaphragm.
5)
Spontaneus pneumoperitoneum
6)
Idiopathic pneumoperitoneum
7)
Pneumatosis cystoides intestinalis (gas cyst of the intestine. a very rare
entity usually associated with cararrhal enteritis)
8)
Transposition of gas from pneumothorax or lung bullae
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