Presentation
Epigastric pain.
Patient Data
A 2 cm structure containing fecal-like material and gas is seen arising from D3, however no oral contrast enters it. No bowel wall contains it and it displaces the common bile duct and pancreatic head anteriorly. Small volume of free fluid posterior to the diverticulum, tracking into the right anterior pararenal space. No intra- or extra-hepatic bile duct dilatation. No peripancreatic fat stranding or fluid around the body or tail. No pneumoperitoneum.
The remainder of the intra-abdominal and pelvic organs are unremarkable. Tampon in situ. Rectus abdominis diastasis. Bibasal atelectasis.
Conclusion
Appearances are consistent with a retroperitoneal perforation, likely secondary to perforated duodenal ulcer.
Case Discussion
Surgery confirmed the perforated ulcer which was oversewn.
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