Clinical Feature and the Treatment of Perforated Peptic Ulcer Diseases

Peptic Ulcer disease is a condition when excessive acid pepsin condition makes a foramen (perforation) in the gas containing hollow viscous of the abdomen.

Clinical feature of perforated peptic ulcer disease

1.       History of previous peptic ulcer disease and non steroidal anti inflammatory drug (NSAIDs) intake.

PUD perforation

2.       Abdominal pain; which is sudden in onset, severe in intensity. The distribution of the pain follows the spread of the gastric contents over the peritoneum. Pain initially develops on the upper abdomen and rapidly become generalized. Pain is also being felt on the tip of the shoulder due to the irritation of the diaphragm. The pain is accompanied by shallow respiration due to limitation of the diaphragmatic movement and by shock.

3.       The muscle of the abdomen become board like rigid.

4.       Bowel sounds are not audible.

5.       Liver dullness to percussion decreases due to the presence of gas under the diaphragm.

6.       Features of shock, such as tachycardia and low blood pressure and rapid thin thread pulse can be found.

Investigations

1.       Plain X ray of the abdomen in erect posture, showing both domes of the diaphragm, anterior-posterior view.

2.       Serum electrolytes.

3.       Ultrasonography of the whole abdomen.

4.       Estimation of the blood urea level.

5.       Water soluble contrast swallow will confirm the leakage of the gastrodeodenal content. 

Treatment

Immediate resuscitation of the patient. Nothing per oral is given. A ryles tube is inserted and gastric content can be aspirated to ensure gastric decompression.

Intravenous fluid is start to recover the patient from shock and correct the dehydration. Antibiotic is start in the parenteral route. After proper resuscitation surgical correction of the perforation is done under general anesthesia by making an upper midline incision.