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Case of perforated peptic ulcer treated conservatively
H Nakamura1, H Kinoshita, M Higashino
1Second Department of Surgery, Osaka City University Medical School, Japan.
Osaka City Medical Journal
|December 1, 1994
Summary
A perforated peptic ulcer case highlights the need to re-evaluate emergency surgery indications. Conservative management may be suitable even with free air, challenging traditional surgical protocols.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
Background:
- Peptic ulcer disease is common.
- Perforated peptic ulcer typically requires emergency surgery.
Observation:
- A 51-year-old man presented with epigastric discomfort and tarry stool.
- Physical examination revealed a hard abdomen with tenderness but no peritoneal rebound.
- Initial lab work was normal except for elevated C-reactive protein (CRP).
Findings:
- Chest X-ray confirmed free air, indicating upper digestive tract perforation.
- Despite free air, peritonitis symptoms and signs diminished.
- The patient was successfully treated conservatively with supportive care.
Implications:
- This case challenges the absolute necessity of emergency surgery for all perforated peptic ulcers.
- Conventional indications for surgical intervention in perforated peptic ulcer may require re-evaluation.
- Conservative management could be a viable option in select cases of perforated peptic ulcer.