Older gentleman with know duodenal ulcer. 1 day history of upper abdominal pain. Defaulted from surveillance endoscopy and medications.
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Scattered foci of gas throughout the abdomen with a upper abdominal predominance in keeping with a pneumoperitoneum.
Small volume perihepatic and pelvic free fluid.
Defect in the lateral wall of the 2nd part of the duodenum with a linear gas track at this site suggesting the site of perforation.
Minor right basal consolidation.
A laparotomy was performed which identified a 1cm hole in the second part of the duodenum, consistent with the CT findings.