Surgeons have realized the value of the roentgenographic examinations as an aid in the diagnosis of perforated peptic ulcer for some time. We have been able to demonstrate that a multiple position technique significantly increases the diagnostic accuracy, as compared with a single film taken in the upright position, which is frequently all that is made.
Popper1 advocated the upright position as early as 1915 to demonstrate free air in the abdominal cavity. According to Cole and Berne2 the accepted diagnostic accuracy of the x-ray examination in perforated peptic ulcer is between 75% and 80%. Kornblum3 reported the incidence of pneumoperitoneum in 87 cases of perforations of the gastrointestinal tract. The free air was demonstrated in 59.3% of the stomach perforations and 70.4% of the duodenal perforations. Vaughn and Brams4 utilized either the upright or the lateral decubitus position and obtained an accuracy of more than