Preoperative diagnosis of perforated duodenal ulcer by sonography: Report of a case

Acute abdomen is one of the chief problems encountered by physicians in the emergency service. Perforated peptic ulcer (PPU) is one cause of acute abdomen in which there should be no delay in diagnosis and management. Delayed diagnosis will lead to a high risk of mortality, especially for the elderly. Traditionally, a pneumoperitoneum on imaging studies with a related medical history suggests a diagnosis of PPU. However, relying on the presence of free air on imaging studies, one-quarter to one-third of cases with PPU may be missed. The case of a 62-year-old man with right upper quadrant tenderness and rebound pain is presented here. Detailed sonographic survey revealed a perforated tract on the anterior wall of the duodenal bulb but no free air. A preoperative diagnosis of PPU was made by sonography instead of acute cholecystitis suggested by computed tomography.