A RARE SURGICAL COMPLICATION OF THE NONSTEROIDAL ANTI-INFLAMATORY DRUGS WITH ASSOCIATED PNEUMORETROPERITONEUM

Abstract

Perforation of a duodenal ulceration, caused by chronic nonsteroidal anti-inammatory medication treatment, is a rare clinical event. Symptoms are usually insidious and non-specic, so only clinical suspicion can lead to a proper diagnostic and optimal clinical management. We present a case of perforated duodenal ulceration, with pneumoretroperitoneum, which presented to the hospital with diffuse abdominal pain, sub-fever and altered general condition. CT scanning was essential in diagnosing the location, the extent and the nature of the lesion. No abnormalities were evident at the initial inspection of the peritoneal cavity. After mobilization of the duodenum, a perforation was found on the medial wall of the duodenum II, near the lower knee, through which the bile owed. Perforation suture, nasoduodenal tube and postoperative parenteral nutrition were the key points of the surgical management.