Robert L. Lebowitz, M.D. Children' s Hospital, Harvard Medical School Boston, Massachusetts

18-month-old baby girl with bilateral reflux on family screening reflux study. Persisted after one year. Underwent bilateral Politano-Leadbetter reimplants. Developed pneumoperitoneum. At reoperation was found to have laceration of the peritoneum and the small intestine.

Injury to the peritoneum and/or the small bowel are well-recognized complications in this type of reimplantation where the ureter is brought back into the bladder near the peritoneal reflection, the pouch of Douglas.

The abdomen film showed air on both sides of the bowel wall (Rigler sign). This is a classic radiological sign of pneumoperitoneum.   (Figure1)