Gastric perforation is less common than previously, largely due to the common use of PPI medication.  

Typically, ancillary signs are observed on CT: extra-luminal gas,  peritoneal fluid, thickening of the gastric wall, rather than the 'hole' in the stomach itself from the perforation.

This case illustrates a large perforation in the anterior aspect of the stomach with large volume hydroperitoneum. 

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