Presentation
Upper abdominal pain for one day.
Patient Data
Localized perforation at the anterior wall of the proximal-most part of first part of duodenum, delineated by air tract and connected to a localized small paraduodenal collection confined by the inferior border of left lobe of the liver anteriorly, gallbladder wall laterally and omentum inferiorly. Omental fat stranding and diffuse gallbladder wall thickening are noted. No pneumoperitoneum, no ascites, and no lesser sac collection.
Green arrows point to the site of perforation at the anterior wall of the duodenal bulb.
Case Discussion
Bowel gas sometimes act as a negative contrast delineating bowel pathology. Here, it delineates the tract of perforation confirming the connection of the bowel lumen to the paraduodenal collection. Perforation of peptic ulcer is a serious complication that increases morbidity and mortality and is considered as a surgical emergency.
This type of perforation doesn't cause free intraperitoneal air or collections, so couldn't be detected on plain radiographs.
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