Perforated Duodenal Ulcer – CT

Perforated duodenal ulcer. This 43 year old man presented with acute abdominal pain. A chest radiograph showed free gas under the diaphragm. Transverse CT image on the left shows the free gas anterior to the liver (yellow arrow), as well some free fluid (white arrow). On the coronal image (middle and, magnified, right) you can see the defect (arrow) in the wall of the duodenum (D), due to a perforated peptic ulcer.