A 60-year-old man was referred as an emergency with a 3 month history of left sided abdominal pain and weight loss. He had no other medical problems and took no medications. An endoscopy was performed. This demonstrated a normal oesophagus and stomach and a fleshy mass in the first part of the duodenum with surrounding slough. As this was presumed to be malignant, biopsies were taken. Computed tomography (CT) scan of the abdomen was performed which showed a large, complex, loculated intra-abdominal collection containing air. Results from duodenal biology showed the presence of ulcer slough and liver tissue. The patient was diagnosed with a perforated duodenal ulcer, which had occurred some months previously, and which had eroded into the liver. He was observed and treated with intravenous antibiotics. The patient was discharged on day 14. Follow-up CT scan at 6 weeks showed complete resolution of the collection.

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