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A middle-aged patient with cystic fibrosis presented to the clinic with progressively worsening constipation requiring over-the-counter laxative use. He was not in distress, and physical examination was notable for percussive tympany over the right upper quadrant with caudally displaced liver. Review of laboratory analysis was unremarkable, including normal cell count, electrolytes, hepatic function and negative coeliac panel. Assessment of previous CT imaging of the abdomen unexpectedly revealed air under the right diaphragm (figure 1 …
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
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