Case contributed by Mohammad Osama Hussein Yonso


Upper abdominal pain for 2 days. Abdominal tenderness in the right hypochondrial region. No past history of surgery or trauma.

Patient Data

Age: 20 years
Gender: Male

Free gas under the diaphragmatic domes is seen (pneumoperitoneum)

No additional findings are noted.

Case Discussion

Although not shown, this patient initially underwent an ultrasound, which showed fat stranding surrounding the duodenum, thickened walls of the duodenum and gastric outlet, a slight thickening in the gallbladder wall, and a small amount of free fluid in the pelvic area. Given these findings, it was then suggested to perform an erect abdominal radiograph which showed the presence of pneumoperitoneum. In this setting, this is most likely due to a perforated gastric or duodenal ulcer.

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