"A
37-year-old male presented in our hospital with moderate epigastric
pain for three months. Around one week before examination, the pain
became more severe, but he didn’t recognize a suddenly pain.
Clinical examination revealed no muscle guarding and rebound
tenderness.
Abdominal
ultrasound images showed unconcentric wall thickening of the
gallbladder. Beside the more thickening wall of gallbladder, a
hyperechoic of air collection was found. This air collection was
continuous with small hyperechoic air spots inside duodenum. A
perforated duodenal ulcer with air leakage was suspected.
CT-Scan
confirmed air collection beside a thickening gallbladder wall.
Blood
test indicated and raised of white blood cells (10,350 / mL) with low
level of CRP (0.9 mg/L) and possitive Helicobacter Pylori test.
Without
surgery, the patient pain released and the air collection was
disappear in ultrasound and CT-Scan images for one month follow-up.
Gastroduodenal endoscopy showed a healing ulcer in the anterial wall
of duodenum. White blood cell count returned to normal."
This
is a case of perforated seal-off duodenum revealed by ultrasound and
confirmed by CT-scan later and successfully management without
surgery.
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