Introduction: Pneumoperitoneum is usually caused by perforation of a hollow viscus - duodenum, stomach, small or large bowel. We report a case of an appendicular perforation causing pneumoperitoneum causing confusion in diagnosis and management. Case summary: A 45 year old lady presented with acute right lower quadrant pain and vomiting for 2 days. There was no history of fever. She is a known diabetic with CKD on medication.
On examination, she was afebrile with a pulse of 110 beats per minute and normal blood pressure. Abdominal examination revealed tenderness and guarding in the right lower quadrant; the rest of the abdomen was soft with no signs of generalised peritonitis; free fluid was present; bowel sounds were absent. Preoperative blood investigations were normal with WBC - 6,800 cells/mm2. An erect abdominal X-ray showed air under both domes of the diaphragm. A clinical…
