Perforated gastric ulcer with hepatic abscess

Case contributed by Ammar Haouimi


History of acute severe epigastric pain 3 weeks ago. The abdominal ultrasound at that time was normal. Progressively the patient developed a right upper quadrant pain with fever, anorexia, malaise, and leukocytosis. MRI requested to rule-out intra-abdominal sepsis.

Patient Data

Age: 50 years
Gender: Male

The MRI sequences demonstrate:

  • an ill-defined left hepatic lobe mass, composed of numerous lesions of various size and shape, of low signal on T1, heterogeneous high signal on T2 with a peripheral thin rim of enhancement and perilesional edema of high T2.
  • a focal defect of the gastric wall is noted at the anterior wall of the antrum with a small intramural abscess 20 x 13 x 10 mm (well-visualized on postcontrast sequences), in continuity with another small collection of interhepatogastric location
  • a small simple hepatic cyst is noted in segment 4 as well as a small hemangioma of the segment 3
  • enlarged periportal lymph nodes are noted


Annotated image

Annotated images;

  • red arrow: probable location of the focal gastric wall defect
  • yellow arrow: abscess of the gastric wall

Case Discussion

MRI features of a perforated gastric wall with an intramural abscess in continuity with a small interhepatogastric collection with a large abscess formation of the left hepatic lobe; which was confirmed at surgery as a perforated gastric ulcer.


Additional contributor: ZE. Boudiaf, MD, CHU, Constantine Algeria

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