Abstract
Background: The incidence of posterior gastric perforation worldwide is low; the literature has no previous record of its occurrence in Liberia. The diffuse symptoms of a perforated posterior gastric ulcer, delay by patients before they present to hospital, and the lack of skilled personnel and facilities in Liberia to diagnose and treat this condition increase the mortality associated with posterior gastric perforation. Objective: To report the first case of posterior gastric perforation encountered in Liberia. Materials and Method: Case report. Case Presentation/Report: A 44 year old male was referred to John F. Kennedy Memorial Hospital (Liberia’s principal teaching hospital) with a diagnosis of gastritis after six days of worsening epigastric pain. He had a history of NSAID use for a chronic leg and foot ulcer. Physical examination revealed a moderately distended, markedly tender abdomen characterized by guarding, rigidity and low-pitched bowel sounds. Patient was resuscitated with intravenous fluids, antibiotics and analgesics. An emergency exploratory laparotomy subsequently performed revealed a large collection of purulent peritoneal fluid, a 3 × 4 cm perforation on the posterior wall of the stomach and a 3 × 2.5 cm perforation of the transverse mesocolon. The perforations were repaired and the patient recovered satisfactorily. Conclusion: Though relatively rare and associated with a high morbidity and mortality, this case report shows that the paucity of reported cases of posterior gastric perforation may also be attributable to lack of specialist staff with capacity for clinical diagnosis and surgical intervention in a resource poor setting. Identifying patients with gastric perforation and having the skill to repair the perforations significantly enhance the clinical outcome.
Highlights
Posterior perforation of gastric ulcer is an uncommon clinical condition
The diffuse symptoms of a perforated posterior gastric ulcer, delay by patients before they present to hospital, and the lack of skilled personnel and facilities in Liberia to diagnose and treat this condition increase the mortality associated with posterior gastric perforation
Though relatively rare and associated with a high morbidity and mortality, this case report shows that the paucity of reported cases of posterior gastric perforation may be attributable to lack of specialist staff with capacity for clinical diagnosis and surgical intervention in a resource poor setting
Summary
Posterior perforation of gastric ulcer is an uncommon clinical condition. Its occurrence may be masked by the diffuse nature of symptoms of this pathology leading to delays in patient presentation to the surgeon and attendant increase in morbidity and mortality. Delay in presentation to the hospital and in making the decision to explore the patient because of the lack of skilled manpower, pose a critical challenge. This case report seeks to benchmark this first ever recorded incidence of posterior gastric perforation in Liberia. The diffuse symptoms of a perforated posterior gastric ulcer, delay by patients before they present to hospital, and the lack of skilled personnel and facilities in Liberia to diagnose and treat this condition increase the mortality associated with posterior gastric perforation. Identifying patients with gastric perforation and having the skill to repair the perforations significantly enhance the clinical outcome
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