Presentation
Severe abdominal pain with generalized abdominal tenderness.
Patient Data
Focal mural defect of the anterior wall of the duodenal bulb with adjacent extraluminal air bubbles as well as in the gastrohepatic ligament and under the left hemidiaphragm. Intraperitoneal effusion, extensive fat stranding with moderate thickening and enhancement of the peritoneal reflections. Reactive thickening with enhancement of the small bowel mainly the ileal loops.
Dysmorphic liver (history of right hepatectomy for hydatid cysts) with partially calcified hydrated cyst adherent to the right hemidiaphragm.
Annotated images: the green arrows indicate the site of duodenal perforation.
Case Discussion
CT features of perforated duodenal ulcer with secondary peritonitis that was confirmed at surgery.