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Related Experiment Videos

Abdominal catastrophes.

G P Young1

  • 1Orgeon Health Sciences University, Portland.

Emergency Medicine Clinics of North America
|August 1, 1989
PubMed
Summary
This summary is machine-generated.

A patient presenting with acute abdomen was diagnosed with a perforated peptic ulcer after imaging revealed free air. Early recognition of subtle signs on plain films is crucial for timely surgical intervention.

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Area of Science:

  • Emergency Medicine
  • Gastroenterology
  • Radiology

Background:

  • Acute abdomen presentation requires a broad differential diagnosis.
  • Initial management includes stabilizing vital signs and ruling out immediate life threats like myocardial infarction (MI).

Observation:

  • Patient presented with acute abdomen, stable vitals, and initial negative workup including ECG, abdominal X-ray, and chest X-ray (CXR).
  • Laboratory findings showed hemoconcentration and leukocytosis.
  • Subtle signs of free air were noted on plain radiographs (CXR and decubitus abdominal X-ray).

Findings:

  • Computed tomography (CT) scan confirmed free air within the peritoneal cavity, indicating a perforated viscus.
  • Exploratory laparotomy revealed a perforated peptic ulcer as the final diagnosis.

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  • A history of a possible ulcer was recalled retrospectively.

    • Implications:

    • This case highlights the importance of careful review of imaging, even when initial findings are negative.
    • Subtle radiographic signs of pneumoperitoneum can be missed, necessitating advanced imaging like CT.
    • Prompt diagnosis and surgical intervention are critical for managing perforated peptic ulcers.