Perforated peptic ulcer

Case contributed by Dr Fakhry Mahmoud Ebouda


Acute severe epigastric pain.

Patient Data

Age: 50 years
Gender: Female

Chest x-ray


Free air under the diaphragm suggesting pneumoperitoneum.


Urgent abdominal enhanced CT scan shows extravasated linear air tract is seen located at the proximal first part of the duodenum anteriorly as well as other areas of the peritoneum. Associated circumferential thickening of the related duodenum as well as haziness and mild stranding of the surrounding omentum and mesentry. Consequent large amount of free intraperitoneal air and fluid.

Annotated image

Arrow pointing to site of active air leak.

Case Discussion

CT findings are suggestive of a perforated ulcer from the 1st part of the duodenum with active air and blood leak.  The patient underwent urgent laparotomy that confirmed the diagnosis of a perforated peptic ulcer

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