Small perforated ulcer in the lateral aspect of the second portion of the duodenum. Multiple locules of free intraperitoneal air in the upper abdomen. Small amount of perihepatic fluid and stranding, and a small amount of ascites elsewhere. Perihepatic fluid is high density (75 Hounsfield units), consistent with a mixture of oral contrast and reactive fluid. Moderate distention of the stomach with oral contrast. Few oval filling defects surrounded by oral contrast within the lumen of the pylorus and first portion of the duodenum could represent ingested material or intraluminal clot from the ulcer if bleeding is present.