CT
A linear radiopaque structure measuring approximately 4.2 cm in length is seen along the third part of the duodenum. It has an average density of 140 Hounsfield units (HU). Its proximal 1.6 cm is lying within the duodenal lumen whereas its remaining part is penetrating through the anterior wall of the duodenum and lying extra-luminally. Mild focal thickening of the third part of the duodenum is seen. Mild fat stranding is seen in the surrounding mesentery. No oral contrast extravasation is seen. No free fluid or collection is seen. No pneumoperitoneum is seen as well.
Enlarged coarse liver with cirrhotic changes and associated features of portal hypertension (splenomegaly, enlarged portal vein & splenic hilum varices).
Based on those radiological findings, possibility of sealed perforation of third part duodenum caused by ingested fish bone was raised. After CT scan, a detailed history was taken again which was positive for fish meal a few weeks back.