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Periportal free gas sign of upper gastrointestinal perforated viscus

Case contributed by Pooya Bahari Khorram
Diagnosis almost certain

Presentation

Acute abdominal pain.

Patient Data

Age: 65 years
Gender: Male

Free intra-peritoneal gas in the lesser sac and around the main portal and left veins.

Case Discussion

Free gas in the periportal region, without evidences of gas in portal vein wall, is highly suggestive for upper GI visceral perforation. The patient went onto upper endoscopy and a perforated peptic ulcer was identified the in lesser curvature of the stomach.

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