Almuebid Abdullah M, Alsadah Zainab Y, Al Qattan Hussain, Al Mulhim Abdullah A, Alfaraj Dunya
Emergency Medicine, King Fahad University Hospital, Dammam, SAU.
Emergency Medicine, King Fahad University Hospital, Alkhobar, SAU.
Cureus. 2021 Jan 5;13(1):e12513. doi: 10.7759/cureus.12513.
Peptic ulcer is a defect in the mucosal layer of the stomach or duodenum that extends into the deeper layers of their walls. Patients with peptic ulcer disease (PUD) may be asymptomatic or have mild abdominal discomfort. It is one of the common etiologies of perforated viscus resulting in secondary peritonitis, a life-threatening condition that carries high risk for morbidity and mortality especially in those who present late to the hospital or due to unrecognized and misdiagnosed perforation. Early detection of perforation of peptic ulcers should be based on clinical data and imaging techniques. We report a case of a 56-year-old female who presented to our ED with right upper quadrant (RUQ) pain radiating to the right shoulder, alleviated by food, and not aggravated by anything. On examination, the patient was vitally stable, tenderness in the RUQ was appreciated, and Murphy sign was positive. Thus, she was diagnosed with perforation of anterior first part of the duodenum. What makes our case peculiar is the presentation of biliary colic in the setting of perforated peptic ulcer.
消化性溃疡是胃或十二指肠黏膜层的缺损，可延伸至其壁的深层。消化性溃疡病（PUD）患者可能无症状或仅有轻度腹部不适。它是导致继发性腹膜炎的内脏穿孔常见病因之一，继发性腹膜炎是一种危及生命的疾病，尤其是对于那些就医延迟或因穿孔未被识别和误诊的患者，其发病率和死亡率风险很高。消化性溃疡穿孔的早期检测应基于临床数据和影像学技术。我们报告一例56岁女性病例，该患者因右上腹（RUQ）疼痛放射至右肩部就诊于我们的急诊科，进食后疼痛缓解，且未因任何因素而加重。检查时，患者生命体征稳定，右上腹有压痛，墨菲氏征阳性。因此，她被诊断为十二指肠第一部前壁穿孔。我们病例的特殊之处在于，在消化性溃疡穿孔的情况下出现了胆绞痛。
