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Small pockets of pneumoperitoneum are seen in the supramesocolic space, mainly anterior to the liver, indicating perforation of the upper gastrointestinal tract.
In the second part of the duodenum there is a 4 cm long linear density: after that CT scan was performed, we asked the patient what she had eaten for dinner and we deduced that it was an ingested fish bone, which is the probable cause of small bowel perforation. Another smaller fish bone is evident in the lumen of a loop of mid-distal ileum in the right iliac fossa.