Synchronous gastric and duodenal peptic perforation: a rare case report

Abstract

Peptic perforation remains a common entity with varied reasons behind its presentation. Although attributed to its high incidence a double blowout one at duodenum and the other at gastric antrum makes it interesting and intriguing as well. Here presenting such a rare entity. A 35 years male presented with severe upper abdominal pain to emergency department of surgery. His pain started 12 hours before reporting to the doctor with one episode of vomiting and low grade fever. On examination patient had tachycardia, tenderness, abdominal distension and rigidity. An X-ray confirmed gas under diaphragm and without further investigations the patient was explored. With proper consent and preanesthetic checkup, an explorative laparotomy was performed. After draining pus and peritoneal contents the vigilant surgeon observed two perforations of size <1 cm at a distance of 7 cm from each other, one gastric (antral) and other in 1st part of duodenum. After peritoneal lavage the perforations were closed with 3 interrupted non absorbable silk suture with grahams patch. Drains were kept and wound closed. Patient was NBM till day 4 post-operative and started orals thereafter. Hospital stay uneventful and patient discharged on day 12. Though rare but a possibility should be kept in minds of all surgeons about such diverse presentation of peptic perforation. With improving medicinal treatments, diseases are also showing a changing trend. So for being a successful surgeon both knowledge and alertness still remains the key.