Presentation
Upper abdominal pain, nausea, and vomiting.
Patient Data
Age: 65 years
Gender: Male
From the case:
Perforated duodenal ulcer
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Perforation of the medial aspect of the 2nd portion of the duodenum. Reactive inflammation of the 2nd and proximal 3rd portion of the duodenum.
Air and fluid are tracking in the retroperitoneum. Specifically, it is in the anterior pararenal space (anterior margin = peritoneum, posterior margin = anterior renal/Gerota fascia).
Case Discussion
This case provides a good review of retroperitoneal anatomy. The perforated air and fluid track in the anterior pararenal space. Notice how most of the oral contrast did not spill through the ulcer defect. The ulcer crater/defect can be well seen on the coronal reformatted images.
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