Riglers Sign

Also known as the bas relief or double wall sign, Rigler's sign is the most frequently cited plain film manifestation of free air. It refers to the demarcation of both the inner and outer surface of the bowel wall by the simultaneous presence of air in the lumen and outside the serosa (Fig. 7-13). Sometimes, only the serosal surface of the bowel is delineated because its lumen is completely filled with fluid. Large accumulations of air are needed to demonstrate the bas relief sign. Furthermore, it is nonspecific, sometimes simulated by abundant abdominal fat and by distended adjacent bowel loops (Fig. 7-14).

Bas Relief Sign Radiology

A large pneumoperitoneum allows clear demarcation of the bowel walls on plain film.

A large pneumoperitoneum allows clear demarcation of the bowel walls on plain film.

Triangle Sign Pneumoperitoneum

(a) The serosal surface of markedly dilated, thick-walled ileal loops (arrows) is visualized by abundant "creeping fat" of the mesentery in this young man with long-standing Crohn's disease with ileal stricture.

(b) Adjacent gas-distended bowel loops produce an appearance resembling Rigler's sign.

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