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Duodenal perforation

Case contributed by Ian Bickle
Diagnosis certain

Presentation

Older gentleman with known duodenal ulcer. 1 day history of upper abdominal pain. Defaulted from surveillance endoscopy and medications.

Patient Data

Age: 75 years
Gender: Male
ct

Scattered foci of gas throughout the abdomen with a upper abdominal predominance in keeping with a pneumoperitoneum.

Small volume perihepatic and pelvic free fluid.

Defect in the lateral wall of the 2nd part of the duodenum with a linear gas track at this site suggesting the site of perforation.

Gallstones.

Minor right basal consolidation.

Case Discussion

A laparotomy was performed which identified a 1 cm hole in the second part of the duodenum, consistent with the CT findings.

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