Perforated gastric ulcer

Case contributed by Yaïr Glick


Severe epigastric pain, nausea, and vomiting for past 2 days.

Patient Data

Age: 35 years
Gender: Male

Prepyloric ulcer perforating entire thickness of anterior antral wall. Antrum is edematous.

Numerous small locules of free intraperitoneal air, the largest two of which are at the hepatogastric ligament adjacent to the antral perforation and around the falciform ligament.
Large amount of free intraperitoneal fluid.
Abdominal organs (liver, spleen, pancreas, adrenal glands, and kidneys) appear normal.

Case Discussion

Perforated prepyloric peptic ulcer in a patient who had had a duodenal ulcer twice before.

At surgery, there were many tough adhesions between the liver and abdominal wall, between the stomach and the liver and gallbladder, and between loops of small bowel and colon. 1800 ml of free intraperitoneal bilious fluid were evacuated, after which liver was separated from the abdominal wall and the stomach was separated from the liver and gallbladder. A ~2 x 3 cm perforation in the lesser gastric curvature was discovered, from which bilious content was exuding. Release of colonic and small bowel adhesions. When a good approach to the perforation was attained, it was sewn and the stomach was filled with methylene blue - no leak. After the stomach emptied, omentopexy was performed.

The patient recovered well.



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