16歲女性病人騎腳踏車時，與旁邊腳踏車擦撞而滑倒。因被車把撞到的右上腹疼痛，進入本院急診就診，經過檢查與治療，症狀改善而離院。兩天後，因為腹痛愈來愈厲害和高燒，她返回急診複診。腹部X光顯現右腎被氣體包圍的特殊影像，好像是急性腎孟腎炎;腹部電腦斷層則顯示是後腹膜腔腸子破裂。經過緊急于術'證實為十三指腸的第三部分破裂。住院21天後病患康復出院。

We report a case of right upper abdominal pain after hit by the bike handle. Her abdominal pain was resolved and was send home from our Emergency department (ED) at the first day after trauma. However 2 days after, her abdominal pain gradually worsened with accompanying high grade fever prompting her to seek consultation again at our ED. Abdominal x-ray showed gas pattern surrounding her renal shadow resembling acute emphysematous pyelonephritis. Abdominal computerized tomography proved the
retroperitoneum hollow organ perforation with normal appearance of the right kidney. And after emergency laparotomy, it was confirmed that there was perforation of the 3rd portion of the duodenum. Patient was confined in our institution for a period of 21 days and fully recovered upon discharged