In which of the following conditions is air under both sides of diaphragm visualized -a) Perforated Meckel's diverticulumb) Uterine rupture following illegal abortionc) Perforation of duodenal ulcerd) Liver abscesse) Ruptured appendix

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 - Inflammation (diverticulitis, 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 - Spontaneous - Iatrogenic - iatrogenic perforation of uterus or vagina - culdocentesis - tubal patency test 5) Gas forming peritonitis 6) Pneumothorax with pleuroperitoneal fistula