Perforated duodenal peptic ulcers are often not considered when making a differential diagnosis of abdominal pain, especially in the context of sickle cell disease, and cases have not been frequently described in the literature. This study reports the case of a 14 year-old girl with sickle cell anemia complicated with duodenal ulcer perforation, focusing mainly on the imaging aspects. Abdominal CT should be considered as a method for this diagnosis and it requires the knowledge of this entity and its characteristic imaging findings.