Since the rectum is subperitoneal and lies in the midline, gas that escapes from its lumen rises up both sides within the extraperitoneal tissues. Depending primarily on the exact site of perforation, the gas may predominate on one side, but bilateral spread remains evident. In my experience, spread has preferentially been to the posterior compartments. The gas may then parallel the lateral contour of the psoas muscles, outlining the suprarenal and subdiaphragmatic tissues (Figs. 8-211 and 8214).
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