Presentation
Patient presented to the emergency department with a 4-day history of epigastric pain on a background of known duodenal ulcers. The pain was constant and burning in nature. Non-peritonitic abdomen with mild epigastric tenderness on deep palpation and voluntary guarding
Patient Data
Plain erect chest x-ray shows free air underneath the left and right hemidiaphragm. Lung fields are clear.
Case Discussion
The patient remained haemodynamically stable and was mostly pain-free with IV Pantoprazole 80mg while in the emergency department.
CT abdomen and pelvis showed a moderate volume of free air in the upper abdomen, although no definite site of hollow viscus perforation was identified. However, inflammation of the superior wall of the pylorus and proximal duodenum was present, suggesting a potential site of perforation that may have spontaneously healed.
The patient was admitted and managed conservatively with nasogastric tube placement, IV Pantoprazole 80mg twice daily, and antibiotics. He was safely discharged from the hospital after 4 days of observation without surgical intervention.
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