Acute Perforation of Peptic Ulcer: Key Diagnostic Criteria

Acute perforation of a peptic ulcer is a serious medical condition that requires prompt diagnosis and treatment. The following are the primary diagnostic criteria used by clinicians to identify this condition.

Clinical Presentation

One of the most telling signs of acute perforation is the sudden onset of severe upper abdominal pain. Patients often describe the pain as sharp or knife-like, and many can recall the exact moment the pain began, sometimes even specifying the time of day. This sudden and intense pain is a key indicator that a perforation of the stomach or duodenum may have occurred.

Physical Examination Findings

Following a perforation, the contents of the stomach or duodenum leak into the abdominal cavity. These fluids are highly acidic and cause significant irritation to the peritoneum, leading to severe abdominal pain. As a result, the abdominal muscles often become rigid, a condition known as "board-like abdomen." Additionally, patients typically exhibit tenderness upon palpation and rebound tenderness, which are strong indicators of peritoneal inflammation.

Imaging and Diagnostic Tests

Radiographic imaging plays a crucial role in confirming the diagnosis. A standing abdominal X-ray or upright abdominal film may reveal the presence of free air under the diaphragm, which is a classic sign of gastrointestinal perforation. In many cases, a CT scan is also performed, as it provides a more detailed view of the abdominal cavity and can detect even small amounts of free air or fluid accumulation.

Conclusion

In summary, the diagnosis of peptic ulcer perforation is based on a combination of clinical symptoms, physical examination findings, and radiological evidence. Prompt recognition of these key indicators is essential to initiate timely surgical or medical intervention and improve patient outcomes.