Sudden onset abdominal pain two days ago. Diaphoretic. BP 160/100. FAST positive.
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Large volume of abdominal free fluid and free gas. Smaller locules of gas are focused around the upper abdomen and there appears to be defect within the posterior wall of the gastric antrum with contrast extravasation at this point and into the stomach as well as into the lesser sac. Some shouldering may be present.
Large volume of free fluid or free gas is in keeping with perforated hollow viscus.
The patient proceeded to theater and underwent a subtotal gastrectomy. Histopathology demonstrated: established transmural hemorrhagic necrosis and necrotic omentum.