Case contributed by Portia D'Anverrs


Right then left shoulder tip pain followed by generalized abdominal tenderness, maximal at the epigastrium. Associated melena and hematemesis. Hb drop from 120 to 67, pallor. Normotensive and normocardic. Past medical history included gastritis one month preceding, commenced on PPI.

Patient Data

Age: 20 years
Gender: Female

Erect chest radiograph demonstrating subdiaphragmatic free gas bilaterally and evidence of the cupola sign

Case Discussion

This case demonstrates pneumoperitioneum in a young patient with no known risk factors of peptic ulcer disease. The patient underwent urgent laparoscopy and was found to have a perforated gastric ulcer. 

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