Pneumogastrography in the diagnosis of perforated peptic ulcer

During the 5 year period ending December 1982, 57 patients underwent operation for perforated peptic ulcer. Pneumogastrography was utilized in nine patients who were suspected of having perforation but who had equivocal physical findings and normal findings on initial roentgenographs. All patients with initial pneumoperitoneum or pneumoperitoneum after gastric insufflation were operated on within 6 hours of admission for a combined mortality rate of 9.7 percent. Patients without free air, initially equivocal examinations, and in whom pneumogastrography was omitted, experienced an average delay of 27 hours. The overall mortality rate in these patients was 28 percent. We conclude that pneumogastrography enhances the sensitivity of plain diagnostic roentgenography in confirming the diagnosis of perforated gastric or duodenal ulcer. Gastric insufflation is recommended whenever perforated peptic ulcer is considered in the differential diagnosis and initial films are inconclusive.