What is the diagnosis

Plain chest radiograph of a perforated ulcer, showing air under the diaphragm.An erect plain chest radiograph will reveal free gas under the diaphragm in excess of 50% of cases with perforated peptic ulcer but CT imaging is more accurate. All patients should have serum amylase performed, as distinguishing between peptic ulcer, perforation and pancreatitis can be difficult.Bailey and love 27e 1125