GI Radiography


Case 15 :
A 60-year-old female presents with acute abdominal pain. Xray-abdomen, USG abdomen, and an X-ray chest taken in erect position are normal. CT scan is requested. What is the diagnosis?

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Imaging Findings

Study shows thickened duodenal wall (D1 segment) along with presence of air along its postero-medial wall (site of perforation).

Diagnosis:

Perforated duodenal ulcer

Discussion:

CT plays no significant role in the initial diagnosis of peptic ulcer disease; however, it is very important in the diagnosis and treatment of complications. Perforation of a peptic ulcer usually results in pneumoperitoneum which is significant enough to be identified on upright or left lateral decubitus plain radiographs of the abdomen. However, sometimes only a very small amount of free intraperitoneal air is present and can only be identified on CT. The finding of extravasated water soluble oral contrast is a rare finding.

Ulcers on the anterior wall of the stomach or duodenum directly abut the peritoneal cavity; therefore, perforation of penetrating ulcers of the anterior wall may result in acute peritonitis with spillage of gastric and duodenal contents. The volume of gas that escapes into the peritoneal cavity depends on how quickly the site of perforation becomes sealed off.

Links and References

Balsara VJ, Haaga JR. The Gastrointestinal Tract. In: Computed Tomography
of the Whole Body, Volume 2
, Eds. Haaga JR, Alfidi RJ. C.V. Mosby, Co., St. Louis;

West OC, et al. Abdomen: Nontraumatic Emergencies. In: The Radiology of Emergency Medicine. Eds. Harris JH Jr, Harris WH. Lippincott,Williams & Wilkins, Philadelphia; 2000:598-601.

Dr Sanjeev Mani, Bandra Holy Family Hospital, Mumbai