Findings:
There are inflammatory changes and thickening of the distal stomach and proximal duodenum with disruption of the proximal duodenum with an adjacent locule of air. These findings, including the free intraperitoneal air, are concerning for a perforated duodenal ulcer. There is perihepatic free fluid. There is hepatic steatosis.

Impression:
Perforated duodenal ulcer resulting in free intraperitoneal air and fluid in the abdomen and pelvis.

Recommendations:
For your training purposes, recommendations are not included in this report.