Diagnosis of Pneumoperitoneum Using POCUS.

Abstract

Point of care ultrasound (POCUS) of the nontraumatic acute abdomen is limited by its low sensitivity for detecting pneumoperitoneum. However, POCUS signs that suggest the presence of free intraperitoneal air have been described in the literature, such as the enhanced peritoneal stripe. We describe a patient who arrived at our emergency department with an acute abdomen that had been present for several hours. POCUS suggested pneumoperitoneum, which was confirmed by abdominal X-ray and the operative finding of a perforated peptic ulcer. This case highlights the potential role of POCUS as a rapid, non-invasive bedside diagnostic tool in emergency settings, especially when access to other diagnostic aids may be limited or delayed. Recognizing characteristic POCUS signs, including an enhanced peritoneal stripe and reverberation artifacts, can guide early decision-making and expedite surgical intervention. Timely identification of pneumoperitoneum is crucial, because delays in diagnosis are associated with increased morbidity and mortality. This case report reinforces the value of integrating POCUS into the initial evaluation of acute abdominal pain, suggesting its use as an adjunct to traditional imaging methods in the emergency department.