Huge hydro pneumoperitoneum reported as complication of perforated duodenal ulcer with interesting images

Abstract

This case has interesting images of huge hydro pneumoperitoneum. It is a rare view in the medical practice and a good point to learn one of the complications of perforated duodenal ulcer and failure of omental patch operation. We reported a case of acute abdominal pain with hydro pneumoperitoneum that appeared as an air fluid line in X-ray. The patient had an omental patch surgery. Two days after the operation he got severe abdominal pain. The X-ray images showed significant huge hydro pneumoperitoneum. He underwent urgent surgical intervention for exploration that detected a large amount of gases, a biliary free fluid and a leak from duodenal ulcer. Omental buttressing was then performed.

Keywords: Abdominal pain; hydro pneumoperitoneum; perforated duodenal ulcer.

Figure 1

First X-ray was in ED which showed pneumoperitoneum with air fluid line

Figure 2

Second X-ray was 2 days after the first operation i.e. omental Graham patch operation, which showed a significant huge hydro pneumoperitoneum

Figure 3

CT Scan was 2 days after omental Graham patch operation, showing massive hydro pneumoperitoneum

Figure 4

CT Scan was 2 days after the first operation, omental Graham patch operation, showing massive hydro pneumoperitoneum

Figure 5

Third X-ray was 6 days after the second operation, omental buttressing, that showing no air or fluid in abdominal cavity