Time to play! [40] : the answer
Thank you for your comments!
Here is the answer clip to this challenging case of duodenal perforation…the lateral radiograph was already pointing to this direction, but it did not alert the clinician initially.
Pocket of gas, debris of foreign material and echogenic fluid can be difficult to distinguish from the inflamed mesentery. In my opinion, trapped gas bubbles mixed with leaked fluid is harder than free gas to detect on ultrasound…