Perforated Duodenal Ulcer

• A 62 years old male presented with sudden acute abdominal pain.

–CT abdomen and pelvis with Oral and IV contrast.

• Marked pneumo-peritoneum with multiple intra-peritoneal discrete small hypodense pockets with air density.
• Ventral to the duodenal bulb and antrum are small collections of extraluminal gas and oral contrast medium  thus confirms an ulcer as the source of perforation.
• Contrast is seen passing from a defect at these part of the duodenum on its anterior surface, medial to GB bed with contrast leakage around liver and air fluid level is detected

-Duodenal ulcer when located at the anterior wall it is perforating; while on the posterior wall it is penetrating ulcer.

– Signs of penetration and perforation

• Wall thickening, luminal narrowing of duodenum.
• Infiltration of surrounding fat or organs (pancreas).
• Extra luminal, intra- or retroperitoneal gas ± enteric contrast medium.
• Presence of intra- and extra peritoneal gas in upper abdomen is essentially diagnostic of perforated duodenum.