Perforated gastric ulcer
Presenting with a few hours of severe abdominal pain: epigastric/supraumbilical with radiation bilaterally. No other associated gastrointestinal symptoms. Elevated lactate. Ischaemic gut?
CT Abdomen and Pelvis
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There is a small amount of scattered pneumoperitoneum, with gas locules clustered around the gastroduodenal transition, where mild fat straining is present and there are signs of pyloric wall discontinuity suggesting a perforated ulcer. The bowel is not dilated and demonstrates normal enhancement of its wall. The multiple colonic diverticula do not have signs of an acute inflammatory process. There is a small amount of free fluid in the pelvis. The liver demonstrates a well-defined 1 cm hypodense nodule in the segment VII that has a benign appearance. Calcified gallstones noted. The spleen, adrenal glands, pancreas, and kidneys are all normal. Minimal atheromatous disease through the abdominal aorta. The lung bases are clear, the heart is enlarged. No suspicious bone lesions.
This patient demonstrates a typical presentation and CT findings of a perforated gastric ulcer. The site of perforation is visible as a region of discontinuity in the stomach wall.