In which of the following conditions is air under both sides of diaphragm visualized -

Answer is 'a' i.e. Perforated Meckel's diveiculum; 'b' i.e. Uterine rupture following illegal aboion; 'c' i.e. Perforation of duodenal ulcer Gas under left hemidiaphragm is due to fundal gas, a normal finding. When gas is present under right hemidiaphragm also it's due to pneumoperitoneum. Causes of Pneumoperitoneum 1) Perforation of GI tract Peptic ulcer Inflamamtion (diveiculitis, appendicitis, toxic megacolon, necrotizing enterocolitis) Infarction Malignant neoplasm Obstruction Pneumatosis cystoides rupture - Iatrogenic-endoscopy 2) Iatrogenic - Surgery, peritoneal dialysis, drainage catheters, biopsies 3) Penetrating abdominal injury. 4) Through female genital tract a) Spontaneous b) latrogenic - iatrogenic perforation of uterus or vagina culdocentesis - tubal patency test 5) Gas forming peritonitis 6) Pneumothorax with pleuroperitoneal fistula