Demographics:
78 years old, Female
Indication:
Concern for bowel obstruction
Findings
Lower chest
- Large hiatal hernia containing the gastric fundus and a portion of the gastric body
- Mild dependent atelectasis
- Coronary artery and mitral annular calcification
Abdomen/Pelvis
- Marked distension of the stomach and proximal small bowel with gradual tapering to normal caliber in the mid jejunum
- Fecalization of contents in the proximal jejunum
- Superiorly-directed diverticulum arising from the distal second segment of the duodenum with marked mural thickening and surrounding inflammatory changes with intermixed locules of extraluminal gas
- Periduodenal fat strand extends about the pancreatic head, though the pancreas is otherwise normal in appearance
- No loculated intraabdominal fluid collection
- Excreted contrast material in the renal collecting systems (the patient had had a previous contrast-enhanced study)
- Heavy atherosclerotic calcification of the abdominal aorta and branch vessels without aneurysm
- Hysterectomy
MSK
- No acute findings
- Advanced degenerative disc disease at T11-T12 and L5-S1
Diagnosis
Perforated duodenal diverticulum
Sample Report
Perforated duodenal diverticulum with adjacent inflammatory changes and small volume pneumoperitoneum. No loculated intraabdominal fluid collection. Recommend surgical evaluation.
Proximal small bowel dilation may represent small bowel obstruction (which could be a cause for diverticular perforation) or ileus secondary to the nearby inflammation.
Discussion