Perforated duodenal ulcer with ingested contrast leak

Case contributed by Dr Chris O'Donnell


Acute epigastric pain. Erect chest radiograph initially reported as "no free gas". Patient deteriorated over 12 hours with hypotension and epigastric pain. CT to clarify.

Patient Data

Age: 75
Gender: Male

Free intraperitoneal gas and fluid containing the ingested contrast (arrow) adjacent to the liver with a focal defect in the superior duodenum leaking contrast (indicative of a perforated ulcer). Note thick-walled, enhancing small bowel indicative of so-called "shock" bowel due to systemic hypotension.

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Case information

rID: 42485
Published: 23rd Jan 2016
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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