Perforated peptic ulcer

Case contributed by Dr Chad Wong

Presentation

4 day history of worsening abdominal pain and diarrhoea. Arrived to ED with profound hypotension and peritonism. History of daily NSAID use for osteoarthritis.

Patient Data

Age: 50
Gender: Female
CT

Irregularity involving distal greater curvature of the stomach with impression of extraluminal oral contrast extravasation. Large amount of free intraperitoneal gas and fluid. Appearances are suggestive of perforated stomach along the greater curvature.

Case Discussion

Patient underwent an emergent exploratory midline laparotomy which revealed a large 7 cm anterior antral perforation and a 3 cm posterior wall perforation of the stomach. Four quadrant peritoneal soiling and food contents within the lesser sac.

A thorough washout and distal gastrectomy with roux-en-Y gastrojejunostomy was performed.

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Case information

rID: 44671
Case created: 1st May 2016
Last edited: 14th Aug 2016
Inclusion in quiz mode: Included

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