Perforated duodenal ulcer

Case contributed by RMH Core Conditions

Presentation

Sudden onset RUQ, epigastric abdominal pain.

Patient Data

Age: 90
Gender: Female
Modality: CT

Moderate volume pneumoperitoneum. High density fluid collections in the right sub diaphragmatic and perihepatic spaces, the right paracolic gutter, and extending into the anterior abdominal wall, likely representing a combination of oral contrast and haemorrhage. A focal defect is present in the superior aspect of the 1st part duodenum and there is oral contrast extending through this into the subhepatic space. This is consistent with the site of perforation.

Dilated (max 8.8 x 9.2 cm) caecum. Right inguinal hernia containing a fluid filled loop of distal ileum and a locule of free intraperitoneal gas. Collapsed distal transverse left, and sigmoid colon. Marked sigmoid and left colonic diverticulosis. No retroperitoneal gas or large volume of retroperitoneal fluid. Calcified but non-aneurysmal and patent abdominal aorta. Coeliac axis osteal stenosis, patent distal vessel. Small sliding hiatus hernia. Otherwise grossly normal appearing stomach and duodenum. Right basal atelectasis and airspace opacification.. Left upper pole parapelvic renal cyst. Markedly raised right hemidiaphragm. Right total hip arthroplasty.

Conclusion

Perforation 1st part duodenum with moderate volume free fluid and gas.

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Case Information

rID: 29812
Case created: 25th Jun 2014
Last edited: 10th Sep 2015
Tag: rng
Inclusion in quiz mode: Included

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