An Endoscopic Approach as a Salvage Strategy in Complicated Perforated Gastric Ulcer: A Case Report

A peptic ulcer is a common gastrointestinal condition, the most serious complication of which is perforation. This is often associated with high morbidity and mortality, particularly in patients taking chronic corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs). Here, we present the case of a 44-year-old Mexican woman with rheumatoid arthritis who presented with acute abdominal pain and clinical signs of peritonitis. Diagnostic imaging confirmed a perforated prepyloric gastric ulcer with pneumoperitoneum. Following multiple unsuccessful surgical interventions due to tissue necrosis and persistent peritonitis, a controlled gastrocutaneous fistula was created using a Foley catheter to control the damage. Following clinical stabilization, persistent leakage prompted an endoscopic approach: the Foley catheter was replaced with a percutaneous endoscopic gastrostomy catheter using the Gauderer-Ponsky technique, two hemoclips were applied to achieve tight closure of the fistulous tract, and a nasojejunal catheter was inserted to restore enteral nutrition. The patient made a favorable clinical recovery, with resolution of the fistula and satisfactory re-establishment of nutrition, and was discharged home. This case illustrates an alternative salvage approach involving endoscopic techniques for damage control and nutritional restoration in patients with complicated gastric ulcer perforations and failed surgical treatment.