Gastric perforation

Case contributed by Alexandra Stanislavsky
Diagnosis certain


Adult male presenting with epigastric pain.

Patient Data

Age: 50 years
Gender: Male

Intravenous and oral contrast enhanced CT demonstrates a large amount of free fluid and gas, dilated jejunal loops with no clear transition point, and induration of the descending colon, the latter two findings suggesting primary pathology in the left side of the peritoneal cavity.

There is a large perforation along the greater curvature of the stomach, through which oral contrast is seen extravasating and pooling in the adjacent soft tissues.

Annotated image

Single coronal image best demonstrating the discontinuity of the gastric wall along the greater curvature, with oral contrast leaking through.

Case Discussion

The most likely etiology is perforation of a gastric ulcer.  Surgical report is pending.  

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