Case of perforated peptic ulcer treated conservatively

We report a patient fifty-one-year old man with peptic ulcer which was treated conservatively. His chief complaints were epigastric discomfort and tarry stool. On admission, no fever was noted, the abdomen was flat and extremely hard, tenderness was noted, and peritoneal rebound was absent. Laboratory data on admission were all normal except for a slightly elevated CRP level. Oral intake was suspended and the patient received infusion. The chest X-ray film on the following day revealed free air, and the diagnosis of perforation of the upper digestive tract was confirmed; however, the symptoms and signs of peritonitis diminished. Therefore, he was treated conservatively. This case suggests that the conventional indications for emergency surgery for perforated peptic ulcer should be re-evaluated.