PMC1388246_01
Computed tomography on the day of arrival. Frontal and transverse projections showing: 1. Intraabdominally distended gastric fundus. 2. Fluid in hernia. 3. Herniated major omentum. 4. Herniated transverse colon. 5. Small bubble of free air, not noticed primarily. 6. Herniated part of duodenum.
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F1
Besides the herniation and an abundance of faecal content in the entire colon, the CT scan was normal (Fig. 1).
Plain X-ray showing placements of tubes. Naso-gastric tube in the intraabdominally located gastric fundus (A). The naso-jejunal tube was passed through the intrathoracic hernia and the end was placed in the proximal jejunum (B).
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F2
A naso-jejunal tube was placed by a guide-wire, passing the herniated and thereby intrathoracically positioned proximal duodenum (Fig. 2).
Perforated peptic duodenal ulcer. The ulcer was found to be a typically punched out peptic ulcer (arrows) with a diameter of 6 mm.
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F3
On the ventral part of the proximal duodenum there was a punched-out benign perforated peptic ulcer with a diameter of 6 mm (Fig. 3).