|
Page 1 of 4 This is a case presentation of Perforated Duodenal Ulceration seen in a 43 yr old man followed by some background, discussion and suggestions for further reading.
Case Report
Mr CC - Perforated Peptic Ulcer
Presenting Complaint
A 43 year old male presents to Accident and Emergency at midnight with severe upper abdominal pain.
History of Presenting Complaint
- At 5.30 pm Mr CC developed a sudden onset of severe upper abdominal pain that was constant with no radiation. He described no nausea or vomiting.
- For the previous two days he had experienced vague symptoms of heartburn and upper abdominal discomfort.
- There was no change in bowel habit and no malaena. He had not felt feverish.
Past Medical History
Mr CC’s GP had diagnosed a peptic ulcer 3 years previously. This had been confirmed with a barium study. He had never had an OGD.
Social History
Mr CC returned from a holiday in the Caribbean one week previously where he confessed to some binge drinking. He is a smoker with a twenty pack year history.
On Examination
Pulse 92, BP 117/63, Temp 37.0 94% on air
In obvious distress.
Pale, clammy.
Abdomen: distended, rigid upper abdomen, with absent bowel sounds.
Bloods
| Hb 15.4 |
Na 144 |
Bilirubin 10 |
| MCV 97 |
K+ 3.8 |
ALP 64 |
| Plt 319 |
Ur 4.7 |
AST 8 |
| WCC 14.8 |
Cr 105 |
|
| CRP 4 |
Amylase 75 |
|
Aterial Blood Gas
| pH |
7.31 |
| pO2 |
9.7 |
| pCO2 |
6.43 |
| HCO3 |
22.4 |
| Base Excess |
-2.4 |
 
Note: There is no sub-diaphragmatic air on the admission CXR.
|
Surgical Tutorials 
; "Image0")
; "Image1")