Syed Arsalan Haider Bukhari, Shabbir hussain, Shabbir Hussain.
Perforated Duodenal Ulcer A Case Report.
J Surg Pak Jan ;6(3):38-9.

Perforation of duodenum is a known complication of duodenal ulcer. In most patients, either a previous history of dyspepsia is available or, patients are known cases of duodenal ulcer. Herein we report a case of perforated duodenal ulcer.

A 43 years old male was brought in emergency department of CMH Bahawalpur with complaint of severe abdominal pain for 4 hours, allied with a swelling in the right inguinal region. The patient was lying listlessly and gave a history of right reducible inguinal hernia for the last 3 years. On the basis of history, an obstructed right inguinal hernia was suspected. The clinical examination however was quite contrary. His abdomen was held rigid and was drawn in. There was a swelling in right inguinal area. On palpation, the abdomen was tender and rigid in the epigastrium and right hypochondrium. There was a positive release sign in the right hypochondrium and right iliac fossa. The hernial sac was vacuous of any viscera and appeared to be filled with fluid. A provisional diagnosis of perforated duodenal ulcer was made, inspite the fact that he had no antecedent history of dyspepsia or epigastric pain and was a non-smoker. His BP was 110/90 mmHg and pule rate was 100/min. Laboratory examination revealed Hb of 12.0 gm% and TLC of 12500/cmm. X-Ray chest revealed gas crescent under the diaphragm. Ultrasound revealed fluid in the pelvis. Patient was resuscitated and emergency laparotomy was performed. A clearly punched out ulcer was seen in the anterior wall of the first part of duodenum, with bile stained fluid in the pelvis, which had also transgressed into the preformed hernial sac on the right side. The ulcer was closed with vicryl and Gordon patching was done. Peritoneal toilet with closure of the mouth of the hernia transabdominally was carried out. The patient made good postoperative recovery and discharged with H2 receptors blockers for 8 weeks and advised followup fortnightly in surgical OPD, CMH, Bahawalpur.

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