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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 August 4; 335(7613): 266.
PMCID: PMC1939776


S Amerasekera, specialist registrar, B Wee, specialist registrar, and G Jones, consultant

A 67 year old man presented with three days of lower abdominal pain and diarrhoea. On examination he was tachycardic and tender in the left iliac fossa. His white cell count was raised, but he had normal urea and electrolytes. He was diagnosed as having diverticulitis and started on intravenous antibiotics and fluids. His chest x ray showed the “continuous diaphragm” sign, which is a classic indication of a pneumomediastinum. Computed tomography confirmed the presence of free intraperitoneal air, secondary to a perforated diverticulum. The patient settled with conservative

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