Perforated duodenal ulcer
Sudden onset RUQ, epigastric abdominal pain.
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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 hemorrhage. 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) cecum. 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. Celiac 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.
Perforation 1st part duodenum with moderate volume free fluid and gas.