Bedside ultrasound examinations performed by emergency physicians are goal-directed studies meant to answer specific questions. These studies are frequently performed in critically ill patients with undifferentiated abdominal pain who are suspected of having intra-abdominal hemorrhage or a ruptured abdominal aortic aneurysm. Patients presenting with a perforated hollow viscus may have a similar clinical presentation. Although detection of the sonographic findings associated with a perforated hollow viscus is not a current study goal, these findings may be readily apparent during the performance of examinations to detect an abdominal aortic aneurysm or intra-abdominal hemorrhage. Therefore, it is imperative that emergency physicians be familiar with the sonographic findings associated with a perforated hollow viscus. Three illustrative cases are presented with a review of sonographic findings.