Question:medium
A patient comes to the emergency department with severe abdominal pain, pulse 112 per minute and systolic BP 80 mm Hg, with the chest X-ray shown below. What is the next appropriate step for this patient?
A patient comes to the emergency department with severe abdominal pain, pulse 112 per minute and systolic BP 80 mm Hg, with the chest X-ray shown below. What is the next appropriate step for this patient?
Show Hint
Air under the diaphragm plus shock = perforation; resuscitate and operate.
Updated On: Jun 23, 2026
- Exploratory laparotomy
- Saline wash of stomach
- Intercostal tube drainage
- None
Show Solution
The Correct Option is A
Solution and Explanation
Step 1: Crescents of gas tracking beneath the diaphragm on an erect chest film mean pneumoperitoneum, the radiological signature of a ruptured hollow viscus.
Step 2: Pair that with a rigid painful abdomen and shock numbers (tachycardia of 112 and hypotension of 80 systolic) and you have perforation peritonitis with circulatory compromise demanding surgery, not observation.
Step 3: After rapid fluid resuscitation the definitive move is emergency exploratory laparotomy to locate and close the leak. A stomach washout cannot fix a hole, a chest drain addresses the pleural space rather than free intraperitoneal gas, and doing nothing would be fatal.
\[\boxed{\text{Exploratory laparotomy}}\]
Step 2: Pair that with a rigid painful abdomen and shock numbers (tachycardia of 112 and hypotension of 80 systolic) and you have perforation peritonitis with circulatory compromise demanding surgery, not observation.
Step 3: After rapid fluid resuscitation the definitive move is emergency exploratory laparotomy to locate and close the leak. A stomach washout cannot fix a hole, a chest drain addresses the pleural space rather than free intraperitoneal gas, and doing nothing would be fatal.
\[\boxed{\text{Exploratory laparotomy}}\]
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