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Abdominal CT scan showing retroperitoneal (a) and intrabdominal free air and a duodenal haematoma (b).
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Abdominal US was negative, but due to his worsening overall condition, the patient underwent a contrast-enhanced CT scan that showed a suspected duodenal perforation in the II portion of the duodenum, with free air in the retroperitoneum and free fluid in the peritoneal space, wall thickening, and duodenal haematoma (Fig. 1a and b).
Duodenal bulb perforation with guidewire.
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The test showed a new perforation in the duodenal bulb, and a guidewire was introduced (Fig. 2).
The second duodenal perforation in the antrum.
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The subsequent laparotomy showed a single perforation on the anterior wall of the duodenal bulb (II type laceration - AAST-OIS), immediately after the pylorus (Fig. 3), while the previous perforation was perfectly closed, as seen at the previous endoscopy.