Presentation
Acute abdominal pain. History of a car accident 1 week before.
Patient Data
Moderate volume of hyperdense ascites due to significant oral contrast leakage into the peritoneal cavity is present. Several foci of extraluminal air are visible in the upper abdomen. Some of the proximal small bowel loops show hyper-enhancing wall thickening. A small mural defect is seen at the peri-pyloric area's superolateral aspect, suggestive of perforated peptic ulcer disease.
The white and yellow arrows point to the extraluminal air and dense ascites due to extravasated contrast. The red arrow shows the site of perforation and the brown points to the enhancing thickened small bowel loops.
Case Discussion
The patient underwent emergent surgery; the surgeon found a perforated ulcer on the pyloric region. The enhancing thickened wall small bowel loops are likely due to peritonitis.
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