case_images: PMC1388246_01
case_images: 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.
case_images: 1471-2482-6-1-1.jpg
case_images: PMC1388246_01_1471-2482-6-1-1.jpg
case_images: F1
case_images: Besides the herniation and an abundance of faecal content in the entire colon, the CT scan was normal (Fig. 1).
case_images: 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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case_images: PMC1388246_01_1471-2482-6-1-2.jpg
case_images: F2
case_images: A naso-jejunal tube was placed by a guide-wire, passing the herniated and thereby intrathoracically positioned proximal duodenum (Fig. 2).
case_images: Perforated peptic duodenal ulcer. The ulcer was found to be a typically punched out peptic ulcer (arrows) with a diameter of 6 mm.
case_images: 1471-2482-6-1-3.jpg
case_images: PMC1388246_01_1471-2482-6-1-3.jpg
case_images: F3
case_images: 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).