Role of Point of Care Ultrasound in the Diagnosis of Perforated Peptic Ulcer

Abstract

Perforated peptic ulcer is a common cause of acute abdomen and intra-abdominal infection in the emergency departments. The diagnosis is usually made by typical history, diffuse abdominal tenderness, muscle guarding and confirmed by x-ray or computed tomography. Despite previous studies point out that ultrasound is superior to plain radiography to diagnose pneumoperitoneum, most emergency physicians are still not familiar with this application. We report a case presenting with diffuse abdominal pain and muscle guarding to the emergency department and the diagnosis of perforated peptic ulcer was made by point of care ultrasound and confirmed by computed tomography and surgery. Case report and literature review. A 75 year old woman presented with dull epigastric pain for one week and developed acute abdominal pain for half day Her vital signs were stable. Physical examination reveled diffuse abdominal tenderness and muscle guarding, especially over epigastrium. Ultrasound showed dirty ascites at Morrison’s pouch, right para-colic gutter and pelvic region, free air above surface of left lobe liver and a perforated hole at pre-pyloric region. Computed tomography and surgical finding confirmed the diagnosis. This case indicates that point of care ultrasound in emergency department can be use to diagnose intraperitoneal free fluid and air. It is also possible to diagnose perforated ulcer at prepyloric region. In addition to abdominal aortic aneurysm screening, we recommend routine use of point of care ultrasound to screen free fluid in dependent regions and free air in nondependent regions for patient presenting with acute abdominal pain in the emergency departments.