Approach to pneumoperitoneum and peritonitis (perforated viscus) Quiz: Ace Your Exams

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A 24-year-old female presents to the emergency department for evaluation of abdominal pain for the past 4 days. The patient reports that the pain began near her umbilicus and migrated to her right lower abdomen, but now involves the entire abdomen. The patient is otherwise healthy and is not sexually active. Temperature is 37.8 ºC (100.0 ºF), pulse is 101/min, blood pressure is 123/77 mmHg and respirations are 18/min. The patient has evidence of abdominal distention, diffuse abdominal tenderness, and rebound pain on physical examination. Bloodwork is obtained and the results are pending. An upright chest radiograph is obtained and is shown below. Which of the following is the best next step in management?

A full-frontal X-ray shows an adult human chest, highlighting the rib cage, lungs, heart, diaphragm, and upper abdomen.
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