ABSTRACT
This chapter presents a case study of a 62-year-old male who is presented to the Emergency Department (ED) with severe epigastric abdominal pain. This patient has a perforated peptic ulcer. Differential diagnoses in this case would include acute pancreatitis, perforated duodenal ulcer, perforated diverticulum/appendix, mesenteric ischaemia, inferior myocardial infarction and ruptured abdominal aortic aneurysm (AAA). In this case, the patient has acute onset severe upper abdominal pain, absent bowel sounds and signs of septic shock. Management should include early goal directed therapy of sepsis, keeping the patient nil by mouth, nasogastric tube insertion and aspiration of gastric contents, urinary catheter insertion with hourly urinary output monitoring and opioid analgesia. The surgical team should be involved from an early stage as should the critical care team if warranted by the patient's condition. The patient will need to be adequately resuscitated and optimised prior to anaesthesia and surgery.
