"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.