In which of the following conditions is air under both sides of diaphragm visualized -a) Perforated Meckel's diverticulumb) Uterine rupture following illegal abortionc) Perforation of duodenal ulcerd) Liver abscesse) Ruptured appendix
Gas under left hemidiaphragm is due to fundal gas, a normal finding. When gas is present under right hemidiaphragm also it's due to pneumoperitoneum.
Causes of Pneumoperitoneum

1)   Perforation of GI tract
- Peptic ulcer
- Inflammation (diverticulitis, appendicitis, toxic megacolon, necrotizing enterocolitis)
- Infarction
- Malignant neoplasm
- Obstruction
- Pneumatosis cystoides rupture
- Iatrogenic-endoscopy
2) Iatrogenic
- Surgery, peritoneal dialysis, drainage catheters, biopsies
3) Penetrating abdominal injury.
4) Through female genital tract
- Spontaneous
- Iatrogenic
- iatrogenic perforation of uterus or vagina
- culdocentesis
- tubal patency test
5) Gas forming peritonitis
6) Pneumothorax with pleuroperitoneal fistula
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