Perforated Peptic Ulcer

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(Frequently duodenal & at times stomach)

Section Editor : Prof. T.K. Parthasarathy

History :

  • Dramatic onset
  • Felt something giving away inside !
  • Generalised abdominal pain
  • Patient is holding on to the abdomen and is afraid to move or turn.
  • May or may not have
  • Tachycardia+
  • Anxious _ uncomfortable in pain.


Palpation : Tenderness (Severe). Rebound tenderness

Rigidity: Often described as board like rigidity. (Rather classic).

Percussion : Liver dullness is lost (Obliterated) (meaning free air in peritoneum)

Work-ups :

Chest x-ray- upright - Usual finding _ presence of free air under the diaphragm.

If clinical suspicion is high and there is no air under the diaphragm on an upright film do a lateral decubitus.


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