Perforation of an Acute Peptic Ulcer

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The following case is reported because perforation of an acute peptic ulcer had occurred 24 hours before operation was performed.

The patient was a man who was admitted to the Cleveland Clinic Hospital about 6:00 p. m. on August 15, 1934. His chief complaint was of “pain in the abdomen.” At 8:00 p. m. on the preceding day, excruciating pain in the epigastrium suddenly occurred while the patient was lying down. This was so severe that it made the patient jump up, and then he was doubled over from pain. Vomiting and a cold, clammy sweat followed, and the pain soon became somewhat less intense. During the night the patient felt better, although he had generalized abdominal discomfort. In the morning, the pain became more severe and seemed to be localized somewhat in the right upper abdominal quadrant. The family physician made a diagnosis of acute cholelithiasis, and morphine was administered hypodermically. This eased the pain slightly, but as the day progressed, the pain increased in severity, and another hypodermic did not relieve it to any appreciable extent.

The past history was irrelevant except that vague gastro-intestinal symptoms had been present for several years, and diagnoses which varied from colitis to disease of the gall bladder had been made.

Physical examination at the time of admittance revealed an asthenic type of individual, 50 years of age, who had anxious facies. The pupils were almost pin-point in size and showed little, if any, reaction—this undoubtedly was due to the morphine. . .



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