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An 87-year-old woman with iatrogenic Cushing's syndrome presented with fever and shock. She had had diarrhea for several days, but after the use of antidiarrheal agents, she had become constipated. On the day before admission, she had begun having diffuse abdominal pain. A plain-film radiograph (Panel A) showed the falciform-ligament sign, which was visible as a linear density (arrow); a nasogastric tube was also visible. The radiograph also showed the Rigler sign (also known as the double-wall sign), indicating the presence of gas on both sides of the bowel wall (arrowheads). A computed tomographic scan of the abdomen showed the falciform ligament (Panel B, arrow), outlined by intraperitoneal free air. Pneumoperitoneum was diagnosed. Laparotomy was performed, and diverticulitis with perforation of the sigmoid colon was found. Despite resection of the lesion and colostomy, the patient died from multiple-organ failure 10 days after admission.
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