Fig.1-Fig.4 show massive ascites (reference marks) and free air (white arrowheads) indicating gastrointestinal perforation. Gastric wall begins to thicken by submucosal edema from Fig.3 (black arrowheads) and extends in the entire circumference of antrum in Fig.7 and Fig.8. Black arrows of Fig.6-Fig.8 is a wall defect of the gastric angle, strongly suggesting gastric ulcer perforation as a cause of symptoms. Surgery revealed a perforation of 1cm size on the lesser curvature side of antrum. It was diagnosed as a benign ulcer by perioperative biopsy.

Reference Case (perforated gastric ulcer): A 37-year-old male with a past history of duodenal ulcer at age of 17 years, developed moderate epigastric pain for a week. The pain suddenly became severe, and he presented to ER because of no improvement over 8 hours. Temperature: 38.7 degrees Celsius. On physical examination, board-like rigidity was noted in epigastrium. There is free air (white arrowhead), wall thickening by submucosal edema (black arrowhead), and black arrow is an acute ulcerative lesion. Gastrografin contrast study of Fig.A showed a gastric ulcer (black arrows) and leakage (white arrows) of contrast medium into free peritoneal cavity. Operative and pathologic finding: benign ulcer perforation (Fig.A: black arrows. White arrow is perforation site).