Velazquez Brandon, Magee Madison, Dove Daniel, Miller Benetta, Moszczynski Zbigniew
Bayonne Medical Center, 29 E 29th St, Bayonne, NJ 07002, USA.
Int J Surg Case Rep. 2025 Sep;134:111723. doi: 10.1016/j.ijscr.2025.111723. Epub 2025 Jul 23.
Perforated peptic ulcer disease (PUD) is a critical condition that can present with atypical symptoms, leading to misdiagnosis and treatment delays. While PUD classically presents with peritonitis, rare cases may induce localized inflammatory responses, mimicking other abdominal pathologies such as acute cholecystitis.
We report the case of a 29-year-old male with recurrent postprandial right upper quadrant (RUQ) and epigastric pain. Despite multiple emergency department (ED) visits, normal initial imaging led to misdiagnoses of gastroenteritis and gastroesophageal reflux disease (GERD) with cannabis-induced hyperemesis syndrome. On his third ED visit, he was diagnosed with a perforated gastric ulcer complicated by acute cholecystitis, requiring urgent surgical intervention.
This case highlights the diagnostic challenges associated with atypical presentations of perforated PUD. The absence of gallstones and initial negative imaging studies contributed to diagnostic delays. Advanced imaging, including computed tomography (CT), plays a crucial role in detecting subtle signs of perforation. Additionally, the inflammatory interaction between the gastric and hepatobiliary systems underscores the need for clinicians to consider ulcer-related complications when evaluating persistent epigastric and RUQ pain.
A high index of suspicion is essential when assessing patients with recurrent abdominal pain despite unremarkable initial evaluations. Early recognition and appropriate imaging can facilitate timely intervention, reducing morbidity associated with delayed diagnosis of perforated PUD and its complications.
穿孔性消化性溃疡病（PUD）是一种危急病症，可能表现为非典型症状，导致误诊和治疗延误。虽然PUD通常表现为腹膜炎，但罕见病例可能引发局部炎症反应，类似其他腹部疾病，如急性胆囊炎。
我们报告一例29岁男性，反复出现餐后右上腹（RUQ）和上腹部疼痛。尽管多次前往急诊科（ED）就诊，但最初的影像学检查结果正常，导致误诊为肠胃炎和大麻引起的呕吐综合征伴胃食管反流病（GERD）。在他第三次前往ED就诊时，被诊断为胃溃疡穿孔并发急性胆囊炎，需要紧急手术干预。
该病例凸显了穿孔性PUD非典型表现所带来的诊断挑战。无胆结石以及最初的影像学检查结果为阴性导致了诊断延误。包括计算机断层扫描（CT）在内的先进影像学检查在检测穿孔的细微迹象方面起着关键作用。此外，胃和肝胆系统之间的炎症相互作用强调了临床医生在评估持续性上腹部和RUQ疼痛时考虑溃疡相关并发症的必要性。
在评估尽管初始评估无异常但仍反复腹痛的患者时，高度怀疑至关重要。早期识别和适当的影像学检查可以促进及时干预，降低与穿孔性PUD及其并发症诊断延误相关的发病率。
