Perforated Duodenal Ulcer
47 year-old with a history of peptic ulcer disease but no recent medical care, who presented with greater than one week of increasing abdominal pain and an episode of hematemesis. Physical exam was not suggestive of viscus perforation or of peritonitis. Endoscopy revealed an ulcer in the proximal duodenal bulb. Due to the proximal bulbar location, only the distal edge was visible (black line in the middle image above). A round defect in the base of the ulcer (arrow) suggested penetration or perforation. The duodenal lumen is at upper right in these images. Subsequent radiographs and surgical exploration confirmed the presence of a subacute perforation. The defect was oversewn and the postoperative course was uneventful.
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