perforated ulcer

[newspeak]

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I was doing questions from canadaqbank, and one of those questions asks about the best test to diagnose a perforated gastric ulcer/or duodenal ulcer, and they choose CT and not endoscopy ... I was wondering wouldnt endoscopy be more accurate?

 

[Fuzuli]

If there's a suspected perforation, you wouldn't want to waste your time with an endoscopy (and cause further iatrogenic damage). Perforation = emergency. After examination, the first test to order would be an upright abdominal X-ray to look for infradiaphragmatic free air. The most sensitive test is indeed CT to detect the free air. It can also be used for differential diagnosis (cholecystitis, pancreatitis, etc.)

 

[adagio]

Hi Fuzuli. I didnt know that endoscopy had no role in management of a perforated ulcer (cant it be fixed endoscopically with a purse string?).

thank you so much

 

[Fuzuli]

Hi Fuzuli. I didnt know that endoscopy had no role in management of a perforated ulcer (cant it be fixed endoscopically with a purse string?).

thank you so much

Nope, if it's perforated, you must operate. What is done in operation differs according to the hemodynamic status of the patient, elapsed time and pertinent medical history of the patient, but it generally involves closing the ulcer with an omental patch and possibly performing a vagatomy.

Keep in mind that endoscopy itself may result in perforation as well.

Hope this helps.

 

[adagio]

Hi Fuzuli, thanks a lot for your clarification. Much appreciated.