Presentation
Acute severe diffuse abdominal pain
Patient Data
Evidence of pneumoperitoneum with free intraperitoneal gas seen at the perihepatic region. Mild to moderate intraperitoneal and perihepatic fluid collection extending to the pelvis. Oral contrast leak is seen free at the perihepatic region with a contrast tract seen extending from the anterior wall of the first duodenal part. Blurred peritoneal fat planes are more prominent at the upper abdomen.
The yellow arrows point to the oral contrast leak and the red arrow points to the pneumoperitoneum.
An intraoperative photo shows a perforation of the first duodenal part.
Case Discussion
Here is a case of a perforated duodenal ulcer, one of the causes of small bowel perforation
In this case, the plain x-ray was negative for gas under the diaphragm due to the small amount of pneumoperitoneum. Ultrasound study showed free fluid collection. CT is the imaging modality of choice in the diagnosis of bowel perforation.
Intraoperative photo contribution by the surgeon Dr. Adel Abdelwahed