CT of Acute Abdomen

Epigastric Pain series 2 EXPERT COURSE Answer [EE Case 9]

Perforated gastric ulcer



There are a large quantity of ascites (reference marks) and free air (white arrowheads) in Fig.4-Fig.6. Fig.4-Fig.9 show edematous thickening (black arrowheads) of wall of stomach, and black arrows of Fig.7-Fig.9 is an acute ulcerative lesion, which leads to diagnosis as perforated ulcerative lesion of anterior wall of stomach. The finding was confirmed at surgery (Fig.A: white arrow).





Reference case (perforated gastric ulcer): A 61-year-old male with a past history of gastric ulcer one year ago, presented with sudden onset of intense epigastric pain which occurred two hours ago. Temperature: 36.1 degrees Celsius. Physical examination showed tenderness, rebound tenderness and muscle guarding in epigastrium. There are free air (white arrowhead) and ascites (reference mark) in Fig.1 and Fig.2, and black arrowheads of Fig.3-Fig.9 indicate wall thickening by submucosal edema of antrum, and gas (black arrow) of Fig.4-Fig.8 is an acute ulcerative lesion. Responding to conservative treatment, abdominal pain was relieved on the next day. Endoscopy performed eight days later revealed a giant ulcer in antrum (Fig.B: white arrows).












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