Covered perforation of a postpyloric ulcer.
A 75 yo, previously completely healthy patient came to my ER and complained about upper GI pain for 3 days, no other complains. The exam showed a very painful and tense abdominal wall upon pressure. Labs got some elevated WBC (11.2 Bil/l) without elevated CRP or any other parameter. The abdominal plain is shown on the right (click the thumbnail for a larger view).