Presentation
Sudden onset of right sided abdominal pain. Felt constipated for last few days. Increased inflammatory markers. Peritonitic.
Patient Data
There is large amount of extra-intestinal air (pneumoperitoneum) mainly anterior to the liver. Significant free peritoneal fluid is also noted.
There is proximal duodenal wall thickening with prominent mucosal enhancement and a defect of the lateral wall in keeping with duodenal perforation.
Case Discussion
Assessing the amount and location of extraintestinal gas and free peritoneal fluid helps when seeking for the site of bowel perforation. Large amount of upper abdominal fluid and gas raise the suspicion of duodenal perforation. The site of the perforation is not commonly seen on CT, but confirms the diagnosis as demonstrated.