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Pneumoperitoneum due to perforated duodenal ulcer

Case contributed by Chris O'Donnell

Presentation

Acute epigastric pain with bloating

Patient Data

Age: 35 years
Gender: Female

Massive free intraperitoneal gas with postive Rigler sign, i.e. gas on either side of the bowel wall seen on the anterior scout view. Note the defect in the duodenal cap posteriorly with gas leaking out (arrow) = site of perforation.

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