Fig. 35

Indirect signs of duodenal disease on X-ray. Chest radiograph (a) shows a small amount of gas beneath the diaphragm (arrows) and the continuous diaphragm sign is also seen (arrowheads). At surgery, a perforated duodenal bulb ulcer was identified. Abdominal radiograph (b) shows pneumoretroperitoneum (asterisks) after duodenal rupture following ERCP. Abdominal radiograph (c) shows a stomach with augmented volume (arrowheads)—gastric outflow obstruction caused by multiple polyps of the duodenum in a patient with juvenile polyposis. Abdominal radiograph (d) shows an air-fluid level in the gallbladder (arrow) and a gallstone at the right iliac fossa (arrowhead), indicative of a gallstone ileus, because of a cholecystoduodenal fistula. Abdominal radiograph (e) shows a large horizontal prosthesis in the upper abdomen (arrowheads) and two smaller vertical prosthesis (arrows) in the horizontal and descending duodenum, which were a palliative treatment for an obstructive duodenal adenocarcinoma. Abdominal radiograph (f) shows an intraluminal soft-tissue density at D2. This was a gastric GIST prolapsing into the duodenum