Complex Ascites with Air Bubbles in Colonic Perforation on POCUS Hemodynamically unstable with rigid abdomen. Patient has history of cirrhosis and prior ascites noted in chart. Could this just be "run of the mill" ascites that is incidental finding? True CT is more helpful in distinguishing fluid types but is there a clue here? Look at all the echos within the fluid moving toward the anterior abdomen. These are gas bubbles/air. Always look for air in the wrong place. Also had pneumoperitoneum detected in RUQ. Patient had initial presentation of colon CA with colon perforation and obstruction. Tiny microbubbles seen rising anteriorly, with posterior enhancement also seen = bowel perforation. Always good to look for the abdominal “a” lines just below the peritoneum anteriorly. Dr. Robert Jones @RJonesSonoEM #Ascites #Air #Bubbles #pneumoperitoneum #Perforation #POCUS #clinical #ultrasound #complex
