Perforated colonic carcinoma mimicking perforated peptic ulcer: an argument for full exploration of the stomach and duodenum.

Perforated peptic ulcer is one of the commonest types of hollow-viscus perforation. Because many of these ulcers are found at laparotomy to be sealed off, some authors believe it is unnecessary to dissect the surrounding tissue from the presumed site of perforation. A patient with a long history of peptic ulcer disease experienced the sudden onset of signs and symptoms of perforated peptic ulcer. On exploration, the omentum appeared to be densely adherent to the pylorus and duodenum. However, no perforation was found when the omentum was dissected free from the stomach and duodenum. Further exploration revealed a walled-off, perforated carcinoma of the transverse colon adjacent to the mesenteric border. As a result of this experience, the authors emphasize that when the findings at operation do not fit the clinical presentation in a patient with a presumed perforated peptic ulcer, a thorough exploration of the abdominal viscera is mandatory to identify the pathologic process.