This is an erect chest xray showing massive quantities of free gas under both left and right hemidiaphragms. It is diagnostic of bowel perforation, and the most common conditions would be perforated gastric or duodenal ulcer, perforated diverticular disease or perforation of a colonic carcinoma. There are a wide range of other possibilities including gastric carcinoma, stercoral perforation of the colon, perforation due to inflammatory bowel disease, etc.