Presentation
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
From the case:
Perforated duodenal ulcer with ingested contrast leak
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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.