Perforated duodenal ulcer

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

Acute epigastric pain.

Patient Data

Age: 40 years
Gender: Male
ct

Small air-bubbles are noted within the peritoneal cavity mainly around the liver and gallbladder (see annotated images) with subhepatic and mesenteric fat stranding and minimal free fluid in the pelvic region.

A focal mural defect of the 2nd part of the duodenum is noted which may indicate the site of the duodenal perforation (see annotated images).

Annotated image

Annotated images:

  • red arrows: extraluminal air-bubbles
  • yellow arrows: site of perforation

Case Discussion

The clinical presentation and CT features are most consistent with a pneumoperitoneum secondary to a perforated duodenum which was confirmed at surgery as a perforated duodenal ulcer.

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