Immediate Management

MR CC was resuscitated and admitted to hospital.
A clinical diagnosis of perforated duodenal ulcer was made.
His case was discussed with the consultant General Surgeon on call.
A urinary catheter was inserted, IV fluid was commenced and regular analgesia was administered. He was placed under hourly observations.

Further Management

The following morning the patient was reviewed and had not improved.
An urgent CT scan was performed.

This was reported as follows:
Within the abdomen there is a large amount of fluid around the right liver lobe. There is free gas within the abdomen as well as free fluids. There is also a small amount of air within the lesser sac suggesting a perforated ulcer.
There is a bilateral pleural effusion and atelectasis of the basal part of both lungs.

Operative Management

The patient was urgently transferred to theatre.

An upper midline incision was made. There was seropurulent fluid in the peritoneal cavity. A perforated Duodenal Ulcer was identified on the D1 anterior surface.
An omental flap was mobilised and the perforation was over sewn with an omental patch.
The patient was washed out in all four quadrants.

PDS loop was used for mass closure.

Post operatively

The patient was transferred to HDU. He received 5 days of Cefuroxime and Metronidazole IV.
Three days post operatively he developed a right sided pneumonia, from which he made an uneventful recovery with the aid of physiotherapy.
Oral intake was commenced three days post operatively and increased as tolerated.
The patient was discharged home nine days post operatively.