Duodenal perforation

Case contributed by Akos Jaray
Diagnosis certain

Presentation

Sudden onset of right sided abdominal pain. Felt constipated for last few days. Increased inflammatory markers. Peritonitic.

Patient Data

Age: 75 years
Gender: Female
ct

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. 

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.