Season 4 Case 26

History: abdominal pain

Season 4 Case 26

Case 26

History: abdominal pain.

Name the sign and what it means.




Rigler's sign of pneumoperitoneum


Rigler's sign = "double bowel wall sign". Seen with pneumoperitoneum (free air).
Remember, what you see on X-rays is based on changes of densities rather than the denisty itself.

  • No air in the bowel = you don't see the bowel
  • intraluminal air = you see the inner mucosal wall
  • extra-luminal air = you see the outer serosal wall

So when air inside + air outside means you see both the inner mucosal and outer serosal walls = double bowel wall sign!