How is it Diagnosed?
Gastroduodenal perforation is a life-threatening condition where a hole forms in the wall
of the stomach or duodenum, often due to peptic ulcer disease. Prompt diagnosis is
critical. The typical presentation includes sudden onset of severe abdominal pain, often
described as sharp or stabbing, which may radiate to the back. Patients often exhibit
signs of peritonitis, including abdominal guarding, rigidity, and rebound tenderness.
Initial assessment includes clinical examination, noting features like hypotension,
tachycardia, and reduced bowel sounds—indicative of acute abdominal crisis. A history
of peptic ulcers, NSAID use, or Helicobacter pylori infection may support suspicion.
The first-line investigation is usually abdominal X-ray in erect position, which may show
free air under the diaphragm, a key sign of gastrointestinal perforation. If X-ray findings
are inconclusive, a CT scan of the abdomen with contrast is highly sensitive and can
confirm the diagnosis, locate the site of perforation, and identify complications like
abscesses or fluid collections.
Blood tests often reveal elevated white blood cell count, signs of systemic inflammation,
and sometimes acidosis. Serum amylase may be mildly elevated but is not specific.
In emergencies, diagnostic laparoscopy or laparotomy may be performed directly to
confirm and treat the perforation if imaging is not feasible or if the patient is
deteriorating.
Timely diagnosis using clinical signs and rapid imaging is vital to reduce morbidity and
mortality from gastroduodenal perforation.