Double Gastric Perforation as a Complication of Peptic Ulcer Disease, a Rare Surgical Entity

Aim: Double gastric perforations are a rare surgical entity and the operating surgeon has to be aware of the possibiity of multiple perforations. Here in we report a case of a 70year old male with double gastric perforation.

Presentation of Case: A 70 year old male patient presented to casuality with complaints of pain abdomen since 3 days and not passing stool and flatus since 2 days. Initial vitals were heart rate 104 beats/min, resp rate 23/min bp 95/65mmhg. Initial resuscitation was done. Chest x-ray and x-ray erect abdomen and pelvis revealed gas under the diaphragm.

Ultrasound abdomen and pelvis revealed- peritoneal collection with air echoes and debris (? Hollow viscous perforation).

Discussion: Patient was taken up for emergency laparotomy and intra op pathology revelaed 2 perforations one in the antrum and one in pylorus of stomach. Biopsy was taken and modified grahams omental patch repair done Patient discharged without any issue and upper GI endoscopy after 6weeks revealed no evidence of malignancy.

Conclusion: The occurance of multile perforations is rare and should always be kept in mind when encountering a Hollow Viscous Perforation. In emergency setting a quick and a safe surgery has to be carried out with thorough peritoneal toilting followed by postoperative medical management of H. pylori infection.