Presentation
Presented with diaphoresis and sudden onset of epigastric pain for 1 day.
Patient Data
Presence of Ryle's tube in the stomach.
Pneumoperitoneum is noted with free fluid in the abdomen and pelvis. Oral contrast leakage is seen at the perihepatic region. Associated with surrounding mesenteric fat streakiness.
The stomach is partially distended with contrast-filled. Thickening of the pylorus and the D1. Smearing of contrast is seen from the thickened D1, a suspicious site of perforation.
The liver is enlarged in size with a smooth outline. No focal liver lesion. No biliary dilatation. Portal and hepatic veins are patent.
The gallbladder is partially distended with no gallstone. Thickened gallbladder wall and minimal pericholecystic fluid with surrounding fat streakiness are seen.
Hyperdense renal calculus (0.6cm) is seen at the mid-pole of the left kidney with no evidence of obstruction.
Foci of calcification at the pancreatic head and body. The rest of the pancreas is normal.
Spleen, right kidney, and both adrenals appear normal. Subcentimeter retroperitoneal and mesenteric lymph nodes.
Minimal bilateral pleural effusion with adjacent collapse consolidation (Right >Left).
Case Discussion
Features are suggestive of a perforated duodenal ulcer. Incidental findings of mild hepatomegaly and left non -obstructive nephrolithiasis.
The patient underwent midline laparotomy. Operative findings revealed a D1 anterior wall defect, measuring 2.0 x 2.0 cm (AP x W) with 4-liter contamination. No postoperative complication occurred.
The patient recovered well and was discharged home awaiting surgical clinic follow-up.
The most common risk factors for duodenal ulcers are non-steroidal anti-inflammatory use (NSAIDs) and Helicobacter pylori infection.
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