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In the right side of the abdomen there is high density material pooling within a lumen. This likely represents a duodenal diverticulum. Medial to this this is a gas filled structure containing solid material measuring 3.7cm. This is not continuous with bowel and is suspicious for a contained perforation. The site of the perforation is not evident. There is a further small gas locule medial to this which is also extraluminal. Marked surrounding fat stranding. No lymphadenopathy. No free intra-abdominal or pelvic fluid.
Hepatomegaly. The liver, spleen, pancreas and kidneys opacify normally, with no evidence of contusion or laceration. Low density lesion in segment VII of the liver likely represents a cyst. The gallbladder, adrenals and bladder are unremarkable.
There is a long segment of colon from the hepatic flexure to the mid transverse colon, which has a thickened and enhancing wall with marked pericolic fat stranding. Luminal narrowing throughout this segment. No overlying subcutaneous stranding. Although this is a portal venous phase study, the SMA opacifies normally. No SMV thrombosis.
Bibasal scarring and bronchiectasis.Haemangioma in L3 body. No lumbar vertebral fracture or malalignment. No paravertebral haematoma. No fracture of the imaged lower ribs. No fracture of the pelvis, sacrum or proximal femora. The sacroiliac joints and pubic symphysis are not widened.
Contained perforation in the central abdomen, with marked associated inflammatory change within the gastrocolic ligament. The site of perforation appears to be an inflamed D3 duodenal diverticulum.
Thickened and enhancing colon from the hepatic flexure to the mid transverse colon with marked pericolic fat stranding and luminal narrowing. These changes are likely reactive to the contained perforation located superiorly however there is quite a distance between the two processes.