JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
RADIOLOGY CASE OF THE MONTH
Abdominal Pain and Nausea: A Case of Visceral Perforation
Jerry Liu, MS, Nancy Emelife, MD, Leslee McNabb, MD, Jeremy Nguyen, MD
A62-year-oldmale presentswith tachycardia and a two-day history of burning abdominal pain with nausea that worsens with meals.
Figure 1A: Coronal CT abdomen post oral contrast
Figure 1B: Axial CT abdomen post oral contrast
Figure 1C: Sagittal CT abdomen post oral contrast
IMAGING FINDINGS
Coronal post contrast computed tomography (CT) of the abdomen (Figure 1A) demonstrates a discontinuity of wall of the lesser curvature of the stomach with active extravasation of oral contrast into the peritoneum. This is also reflected on corresponding axial (Figure 1B) and sagittal (Figure 1C) images where contrast and air can be seen extruding through the defect (arrows). Additional coronal (Figure 2A) and sagittal (Figure 2B) images of the abdomen demonstrate a moderate pneumoperitoneum which is predominantly perihepatic (arrows) as well as a large amount of hyperattenuating free fluid seen throughout the abdomen (arrowheads), likely reflecting a combination of oral contrast and blood products.
Figure 2A: Coronal CT abdomen post oral contrast
Figure 2B: Sagittal CT abdomen post oral contrast
70 J La State Med Soc VOL 170 MARCH/APRIL 2018
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