Presentation
Acute abdomen. Ultrasound was normal according to the resident on call. Chest x-ray then CT were performed.
Patient Data
Age: 70 years
Gender: Male
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Free crescent gas within the peritoneal cavity seen under the right and left hemidiaphragm.
Heart size is normal. Both lungs are clear. No pleural effusion is seen.
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The CT scan demonstrates:
- a large pneumoperitoneum with intraperitoneal effusion (hydropneumoperitoneum)
- a focal perforation of the anterior wall of the bulb is noted.
- distended small and large bowel with no transition point (paralytic ileus?)
- incidental findings:
- small bilateral adrenal masses, probably adenomas
- occlusion of the celiac trunk with splenic infarction
From the case:
Duodenal bulb perforation - massive pneumoperitoneum
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The red arrows indicate the probable site of the duodenal perforation.
Case Discussion
Radiographic and CT features of a massive pneumoperitoneum secondary to a focal perforation of the anterior wall of the duodenal bulb which was confirmed at surgery as a perforated ulcer (5 mm of diameter), unfortunately, the patient died less than 24 hours after surgery.
Additional contributor: A. Ramdani, MD