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

Aterial Blood Gas

Note: There is no sub-diaphragmatic air on the admission CXR.