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CT after oral contrast shows a thickened duodenal wall involving the first part of the duodenum, with an evident defect through which the oral contrast material leaks into the peritoneal cavity, including into the peri- and subhepatic regions. There is also pneumoperitoneum. Signs of peritoneal irritation can be seen also in the form of stranding of the central mesenteric fat with some jejunal wall edema.