Perforated duodenal ulcer resulting in free intraperitoneal air, peritonitis, and small amount of free fluid. Case highlights the utility of oral contrast, which confirms the diagnosis as there is higher density (75 Hounsfield units) perihepatic fluid, indicating a mixture of enteric contents and oral contrast. The luminal out pouching can be confidently seen along the lateral aspect of the second portion of the duodenum. The adjacent intraluminal filling defects could represent clot or ingested material.

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