Gastric perforation

Case contributed by Bahman Rasuli
Diagnosis certain

Presentation

Right hemicolectomy three weeks ago. Now referred with nausea, vomiting, intermittent period of loss of consciousness every time after discontinuation of antibiotics therapy and delirium state. No obvious history of peptic ulcer disease.

Patient Data

Age: 70 years
Gender: Male
ct

There is a defect at the lateral wall of the gastric antrum with contrast extravasation and Locules of gas at this point into the right subhepatic and lesser sac spaces.

Wall thickening of gastric antropyloric region.

Right hemicolectomy and ileocolic anastomosis is seen.

Aneurysmal dilatation of the abdominal aorta starts from the level of infrarenal arteries to the level of aortic bifurcation with a maximum AP diameter of 45 mm and 95 mm length.

Umbilical hernia containing bowel loops is seen.

Thoracolumbar spine degenerative changes such as endplate sclerosis and marginal osteophyte formation are seen.

Case Discussion

The most likely etiology is the perforation of a gastric antrum followed by surgery.

Typically, ancillary signs of traumatic gastric antral perforation are observed on CT: extra-luminal gas,  extravasation of contrast media, and thickening of the gastric antropyloric wall.

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