Presentation
4 day history of worsening abdominal pain and diarrhea. Arrived to ED with profound hypotension and peritonism. History of daily NSAID use for osteoarthritis.
Patient Data
Age: 50
Gender: Female
From the case:
Perforated peptic ulcer
Axial Oral contrast only due to renal function
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.