A Non-invasive 24 Hours Stabilization of Duodenal Ulcer Perforation by a Combination Regimen

Abstract

Surgical repair of perforated gastroduodenal ulcer has been extensively practiced in emergency clinical situations. Non-invasive conservation treatment is regaining the attention towards management of such ulcers. We report the case of a 50-year-old male smoker who presented in the emergency unit with acute generalized abdominal pain and guarding in the epigastric and right upper quadrant region. He is a known regular user of over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDS) for more than 10 years for his osteoarthiritis and myalgias. A differential diagnosis of gastritis and duodenal perforation was made owing to the symptoms and long usage of NSAIDs. He was managed with an intravenous proton pump inhibitor and intravenous antibiotics. This therapy lead to stabilization of the clinical symptoms as well as laboratory and imaging studies.

An Overview of Gastroduodenal Perforation

“…Treatment with intravenous (IV) infusion, nasogastric tube (NGT) decompression, broad spectrum antibiotics, analgesia, and intravenous PPIs is instituted, and a nil by mouth (NBM) policy is initially adopted. Recovery is usually dramatically rapid for the properly selected patient and the right application of the protocol (88), but close observation is important as the development of sepsis or peritonitis may alter treatment radically, and CT-guided drainage may be required (9,(89)(90)(91)(92). The mortality rate for non-operative management in patients with a sealed perforation was 3% as opposed to 6.2% where emergency surgery was performed for PPU (93).…”