PERFORATED PEPTIC ULCER

• More common in males.
• In females, elderly patients are most commonly affected.

Etiology-

• Chronic use of NSAIDs
• H. Pylori infection

Clinical features-

• Classical presentation of perforated duodenal ulcer- patients develop sudden- onset of severe generalised abdominal pain on peritoneum.
• Abdomen exhibits broad like rigidity & does not move with respiration.
• Pain in epigastrium and right iliac fossa.
• Most common site of perforation is anterior aspect of duodenum.
• Gastric ulcers perforate at the antrum or incisural and into the lesser sac.
• Tenderness and rebound tenderness (Blumberg sign) is over abdomen.

Investigations-

1. Complete blood picture.
2. Plain X- ray chest or abdomen in erect position shows collection of free gas under right dome of diaphragm (75- 80%)
3. Serum amylase test should be performed.
4. CT- scan and contrast can show site of perforation and pneumoperitoneum.

Treatment-

1. Aspiration of stomach contents with Ryle’s tube.
2. Drugs- inj. Ampicillin 500mg iv

• Inj. Gentamincin 60- 80mg iv
• Inj. Metronidazole- 500 mg iv

3. Fluids

4. Emergency laprotomy

5. Surgery- Commonly performed surgery is simple patch close i.e. omental patch.