probable site of perforation at lateral wall of D2 segment of duodenum

An approximately 10 x 8 x 3 cm thin walled midline upper abdominal fluid collection encasing the left lobe of liver, extending to anterior subphrenic space demonstrating large air fluid levels – related to hollow viscus perforation.

Mild thickening of proximal duodenum at D1, D2 segments with thickened lateral wall of D2 segment demonstrating thin paraduodenal fluid – suggesting probable site of perforation at lateral wall of D2 segment of duodenum.

Features suggestive of Adynamic ileus.

Trace free fluid in abdomen.

Mildly dilated small bowel loops with multiple air fluid levels without obvious transition point.