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Table 1 Direct and indirect signs of gastrointestinal perforation at Ultrasonography

From: Gastrointestinal perforation: ultrasonographic diagnosis

DIRECT SIGNS Pneumoperitoneum • Increased echogenicity of peritoneal stripe
• Step between air in costophrenic sinus and abdominal gas reflex
  Pneumoretroperitoneum • Air around duodenum and the head of the pancreas
• Vanishing vessels
• Renal rind sign
INDIRECT SIGNS   • Intraperitoneal free fluid
• Air bubbles in ascitic fluid
• Thickened bowel loop
• Bowel or gallbladder thickened wall with ileus